Provider Demographics
NPI:1013569573
Name:SITARAS, JOANNIS TERRY (DDS)
Entity Type:Individual
Prefix:
First Name:JOANNIS
Middle Name:TERRY
Last Name:SITARAS
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 1:442 WINGRAVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5928
Mailing Address - Country:US
Mailing Address - Phone:704-942-5521
Mailing Address - Fax:
Practice Address - Street 1:442 WINGRAVE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5928
Practice Address - Country:US
Practice Address - Phone:704-942-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115301223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice