Provider Demographics
NPI:1033108543
Name:THEODOSIOU, TULA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TULA
Middle Name:
Last Name:THEODOSIOU
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 1:3304 91ST ST
Mailing Address - Street 2:SUITE #1W
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1752
Mailing Address - Country:US
Mailing Address - Phone:718-899-4455
Mailing Address - Fax:718-899-4455
Practice Address - Street 1:3304 91ST ST
Practice Address - Street 2:SUITE #1W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1752
Practice Address - Country:US
Practice Address - Phone:718-899-4455
Practice Address - Fax:718-899-4455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice