NPIMap

Organization Active NPI

Dimoulis Dental P.C.

Doing business as The Dental Office At Melrose Park

  • General Practice Dentistry
  • Melrose Park, IL
National Provider Identifier
1811362791
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.030253 Issued in IL
Legal business name
DIMOULIS DENTAL P.C.
Doing business as
The Dental Office At Melrose Park
Practice address
818 N 19TH Ave
Melrose Park, IL 60160-3726
Phone
(708) 450-1170
Fax
(708) 450-0008
NPI assigned
Dec 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Theodore Harry Dimoulis, D.M.D.NPI 1811370083
Title
Owner/Dentist
Phone
(847) 651-2692

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019.030253 IL Primary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

818 N 19TH Ave
Melrose Park, IL 60160-3726

Mailing address

818 N 19TH Ave
Melrose Park, IL 60160-3726
Phone (708) 450-1170

Other names 1

  • The Dental Office At Melrose Park Doing business as

National Provider Directory

National Provider Directory

Locations

818 N 19th Ave
Melrose Park, IL 60160
Phone (708) 450-1170

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1811362791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 N 19TH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603726",
            "telephone_number": "708-450-1170",
            "fax_number": "708-450-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 N 19TH AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603726",
            "telephone_number": "708-450-1170",
            "fax_number": "708-450-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMOULIS DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-03",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "DIMOULIS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "HARRY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "847-651-2692",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030253",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Office At Melrose Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.