Provider Demographics
NPI:1013220524
Name:SFONDOURIS, TASSOS JOHN (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:TASSOS
Middle Name:JOHN
Last Name:SFONDOURIS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RITCHIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4142
Mailing Address - Country:US
Mailing Address - Phone:410-647-0200
Mailing Address - Fax:410-315-8456
Practice Address - Street 1:900 RITCHIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4142
Practice Address - Country:US
Practice Address - Phone:410-647-0200
Practice Address - Fax:410-315-8456
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics