Provider Demographics
NPI:1346308921
Name:ANGELIDAKIS, ZANNIS (DDS)
Entity Type:Individual
Prefix:
First Name:ZANNIS
Middle Name:
Last Name:ANGELIDAKIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ANGELIDAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3275 STEINWAY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4046
Mailing Address - Country:US
Mailing Address - Phone:718-204-0129
Mailing Address - Fax:
Practice Address - Street 1:3275 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4046
Practice Address - Country:US
Practice Address - Phone:718-204-0129
Practice Address - Fax:718-204-5818
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY485301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220657Medicaid