Provider Demographics
NPI:1083892269
Name:KERIAZES, JOHN N (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:KERIAZES
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 1:3110 37TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2102
Mailing Address - Country:US
Mailing Address - Phone:718-728-3262
Mailing Address - Fax:718-786-6823
Practice Address - Street 1:3110 37TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2102
Practice Address - Country:US
Practice Address - Phone:718-728-3262
Practice Address - Fax:718-786-6823
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0423571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist