Peter Gus Pontikis, D.D.S.
Individual provider Active NPI General Practice Dentistry · Harwood Heights, IL
NPI 1720156003 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720156003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019020871 (IL)
- Practice address
- 7151 W Gunnison St
Suite 100
Harwood Heights, IL 60706-3800 - Phone
- (708) 867-4436
- Fax
- (708) 867-4435
- NPI assigned
- Dec 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160209002791 | IL | Order and Referring Only - Dentist |
5496059529 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019020871 | IL | Yes |
Addresses
Primary practice location
7151 W Gunnison St
Suite 100
Harwood Heights, IL 60706-3800
Mailing address
7151 W Gunnison St
Suite 100
Harwood Heights, IL 60706-3800
Phone (708) 867-4436
Other providers in Harwood Heights, IL
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- Rosario C. Pesce
- Biljana Petrovic
- John Joseph Prestianni III
- Gerald Rebustes
- Renviva Nursing Home Services LLC
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All providers in Harwood Heights, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.