Provider Demographics
NPI:1376663708
Name:DOURMAS, MARIA A (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:DOURMAS
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 164TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4218
Mailing Address - Country:US
Mailing Address - Phone:718-263-7400
Mailing Address - Fax:718-969-3386
Practice Address - Street 1:7015 164TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4218
Practice Address - Country:US
Practice Address - Phone:718-263-7400
Practice Address - Fax:718-969-3386
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046401122300000X
NY214982-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice