Provider Demographics
NPI:1184030769
Name:THANOS DDS INC
Entity Type:Organization
Organization Name:THANOS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:THANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:951-247-5538
Mailing Address - Street 1:24104 SUNNYMEAD BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7732
Mailing Address - Country:US
Mailing Address - Phone:951-247-5538
Mailing Address - Fax:951-242-7666
Practice Address - Street 1:24104 SUNNYMEAD BLVD # C
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-247-5538
Practice Address - Fax:951-242-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29498261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental