Provider Demographics
NPI:1003023318
Name:PETER G MICHALOS DDS INC.
Entity Type:Organization
Organization Name:PETER G MICHALOS DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:MICHALOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-492-0134
Mailing Address - Street 1:4368 DRESSLER RD NW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2771
Mailing Address - Country:US
Mailing Address - Phone:330-492-0134
Mailing Address - Fax:330-492-0410
Practice Address - Street 1:4368 DRESSLER RD NW
Practice Address - Street 2:SUITE 203
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2771
Practice Address - Country:US
Practice Address - Phone:330-492-0134
Practice Address - Fax:330-492-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1598841421OtherNPI