Provider Demographics
NPI:1609514504
Name:DANOS, DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:DANOS
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 1:4437 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4855
Mailing Address - Country:US
Mailing Address - Phone:708-927-4020
Mailing Address - Fax:
Practice Address - Street 1:1809 HOMER M ADAMS PKWY STE A
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5606
Practice Address - Country:US
Practice Address - Phone:618-433-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist