Provider Demographics
NPI:1295036226
Name:MANDROZOS, PATULA NIKOLAOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATULA
Middle Name:NIKOLAOU
Last Name:MANDROZOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14657 BAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2458
Mailing Address - Country:US
Mailing Address - Phone:718-939-7825
Mailing Address - Fax:718-939-7825
Practice Address - Street 1:14657 BAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2458
Practice Address - Country:US
Practice Address - Phone:718-939-7825
Practice Address - Fax:718-939-7825
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist