Provider Demographics
NPI:1053459123
Name:DAMOULIS, PETROS D (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETROS
Middle Name:D
Last Name:DAMOULIS
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 1:95 CENTRE ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2801
Mailing Address - Country:US
Mailing Address - Phone:617-713-0709
Mailing Address - Fax:617-636-3401
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:TUFTS DENTAL ASSOCIATES, DHS-8
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics