Provider Demographics
NPI:1083931414
Name:FILOUKATJIS, DEMETRIUS (DMD)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:FILOUKATJIS
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:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:MEDICAL STAFF OFFICE T9
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7097
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:1 HOLLOW LN STE 108
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-869-3400
Practice Address - Fax:516-869-3403
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice