Provider Demographics
NPI:1982438990
Name:CHRISOULA GEORGACOPOULOS DMD P.C.
Entity type:Organization
Organization Name:CHRISOULA GEORGACOPOULOS DMD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISOULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGACOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-995-7495
Mailing Address - Street 1:10112 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9381
Mailing Address - Country:US
Mailing Address - Phone:708-995-7495
Mailing Address - Fax:
Practice Address - Street 1:10112 191ST ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9381
Practice Address - Country:US
Practice Address - Phone:708-995-7495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental