Provider Demographics
NPI:1053328021
Name:DEMETRIOU, STEVEN C (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:DEMETRIOU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2012
Mailing Address - Country:US
Mailing Address - Phone:978-891-6334
Mailing Address - Fax:978-851-5080
Practice Address - Street 1:1147 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2012
Practice Address - Country:US
Practice Address - Phone:978-891-6334
Practice Address - Fax:978-851-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0265314Medicaid