Provider Demographics
NPI:1447554639
Name:KOURIS, AIMEE LYNN (DDS)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:KOURIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1118
Mailing Address - Country:US
Mailing Address - Phone:312-388-9631
Mailing Address - Fax:
Practice Address - Street 1:2000 SPRING RD STE 502
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1873
Practice Address - Country:US
Practice Address - Phone:630-573-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0251851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice