Alexander Constantine Tzanos, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019027377 Issued in IL

Practice address

411 E Congress Pkwy Ste D
Crystal Lake, IL 60014-6247

Phone

(814) 455-6550

NPI assigned

Jul 2, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Northwest Periodontics & Implants

  • Periodontics
  • Palatine, IL
  • NPI 1235267469
  NPD (past)

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1821250630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E CONGRESS PKWY STE D",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146247",
            "telephone_number": "814-455-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E CONGRESS PKWY STE D",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146247",
            "telephone_number": "814-455-6550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1481 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022803",
            "country_code": "US",
            "telephone_number": "317-988-2022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 N Smith St Ste 125",
            "address_purpose": "LOCATION",
            "city": "Palatine",
            "state": "IL",
            "postal_code": "600672488",
            "country_code": "US",
            "telephone_number": "847-358-3939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TZANOS",
        "first_name": "ALEXANDER",
        "middle_name": "CONSTANTINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019027377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.