Provider Demographics
NPI:1275715252
Name:BOUKAS, SPIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPIRO
Middle Name:
Last Name:BOUKAS
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 1:1129 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE # 401
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-869-8901
Mailing Address - Fax:516-365-3748
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:516-869-8901
Practice Address - Fax:516-365-3748
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0390511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice