Provider Demographics
NPI:1073551768
Name:PAPAERACLEOUS, STAVROS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STAVROS
Middle Name:
Last Name:PAPAERACLEOUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6304 KENWOOD AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-866-6660
Mailing Address - Fax:410-866-1557
Practice Address - Street 1:6304 KENWOOD AVE
Practice Address - Street 2:STE 5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-866-6660
Practice Address - Fax:410-866-1557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588871OtherUNITED CONCORDIA
MD19584OtherAETNA HMO
MD103021OtherCIGNA HMO
MD4976OtherCAREFIRST BC BS