Provider Demographics
NPI:1164431573
Name:PAPAS, ATHENA S (DMD PHD)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:S
Last Name:PAPAS
Suffix:
Gender:F
Credentials:DMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BYRON ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493
Mailing Address - Country:US
Mailing Address - Phone:781-235-8603
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:ROOM 506
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-3932
Practice Address - Fax:617-636-4083
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703834OtherTUFTS SECURE HORIZONS
MA0254398Medicaid
MA38878OtherHPHC FIRST SENIORITY
MAX04343OtherBLUE CROSS BLUE SHIELD
T57231Medicare UPIN
X04343Medicare ID - Type Unspecified