Provider Demographics
NPI:1538379193
Name:POLITIS, CONSTANTINE L (DDS)
Entity type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:L
Last Name:POLITIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1220
Mailing Address - Country:US
Mailing Address - Phone:708-386-8600
Mailing Address - Fax:708-386-8688
Practice Address - Street 1:7327 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1220
Practice Address - Country:US
Practice Address - Phone:708-708-3868
Practice Address - Fax:708-386-8688
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0012481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics