Provider Demographics
NPI:1417031360
Name:MESIMERIS, VASILIOS DIMETRIOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:DIMETRIOS
Last Name:MESIMERIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1319
Mailing Address - Country:US
Mailing Address - Phone:631-587-5870
Mailing Address - Fax:631-587-7947
Practice Address - Street 1:678 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1319
Practice Address - Country:US
Practice Address - Phone:631-587-5870
Practice Address - Fax:631-587-7947
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0449271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics