Provider Demographics
NPI:1265507990
Name:AGALIOTIS, MARIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:AGALIOTIS
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 1:172 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1725
Mailing Address - Country:US
Mailing Address - Phone:973-377-9300
Mailing Address - Fax:973-377-7819
Practice Address - Street 1:172 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1725
Practice Address - Country:US
Practice Address - Phone:973-377-9300
Practice Address - Fax:973-377-7819
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist