Provider Demographics
NPI:1417026345
Name:PSOMIADIS, PARASKEVAS ILIAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARASKEVAS
Middle Name:ILIAS
Last Name:PSOMIADIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:ILLIAS
Other - Last Name:PSOMIADIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:35 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1106
Mailing Address - Country:US
Mailing Address - Phone:215-723-8202
Mailing Address - Fax:215-723-9663
Practice Address - Street 1:35 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1106
Practice Address - Country:US
Practice Address - Phone:215-723-8202
Practice Address - Fax:215-723-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026742-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice