Theodore Harry Dimoulis, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019030253 Issued in IL

Practice address

1645 W Ogden Ave
Unit 506
Chicago, IL 60612-4199

Phone

(847) 651-2692

NPI assigned

Jul 6, 2015

Last updated

Jul 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dimoulis Dental P.C.

  dba The Dental Office At Melrose Park

  • General Practice Dentistry
  • Melrose Park, IL
  • NPI 1811362791
  NPD (past) Authorized official

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

{
    "created_epoch": "1436140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436140800000",
    "number": "1811370083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W OGDEN AVE",
            "address_2": "UNIT 506",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124199",
            "telephone_number": "847-651-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W OGDEN AVE",
            "address_2": "UNIT 506",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124199",
            "telephone_number": "847-651-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMOULIS",
        "first_name": "THEODORE",
        "middle_name": "HARRY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-06",
        "last_updated": "2015-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030253",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 21392",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Dimmick
• Anissa Dimmig
• Katherine Dimond, M.A . CCC-SLP
• Catherine Dimou, M.D.
• John Dimoulis, DDS MS
• Casey Alexander Dimov
• Khawaja Moeen-Ud Din, MD
• Nafisah Din
• Dina Zwiebel LLC
• Amanda Michele Dinardi, OD

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.