Thomas W. Pissios DDS, Ltd
Clinic/Center, Dental in Chicago, IL. Organization (NPI-2).
NPI number1164091864
StatusActive
Last updated in NPPESJun 18, 2021
Details
- NPI
- 1164091864
- Entity type
- Organization (NPI-2)
- Legal business name
- Thomas W. Pissios DDS, Ltd
- Organization subpart
- No
- Enumeration date
- Jun 18, 2021
- Certification date
- Jun 18, 2021
- Last updated
- Jun 18, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Edison Park Dental (Doing Business As)
Practice location
6780 N Northwest HwyChicago, IL 60631-1242
Phone 773-792-3200 · Fax 773-792-3233
Mailing address
6780 N Northwest HwyChicago, IL 60631-1242
Phone 773-792-3200
Authorized official
Thomas W. Pissios
President
7737923200
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