Provider Demographics
NPI:1417080581
Name:MAVROMATIS, VASILIKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VASILIKI
Middle Name:
Last Name:MAVROMATIS
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 1:3909 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1913
Mailing Address - Country:US
Mailing Address - Phone:718-225-4888
Mailing Address - Fax:
Practice Address - Street 1:3909 210TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1913
Practice Address - Country:US
Practice Address - Phone:718-225-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice