Provider Demographics
NPI:1730250754
Name:VALIS, VASILIOS
Entity type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:
Last Name:VALIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320E AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4976
Mailing Address - Country:US
Mailing Address - Phone:847-517-7919
Mailing Address - Fax:216-584-1009
Practice Address - Street 1:1320E AMERICAN LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4976
Practice Address - Country:US
Practice Address - Phone:847-517-7919
Practice Address - Fax:216-584-1009
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190235431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice