Provider Demographics
NPI:1417152810
Name:ZAVRAS, ATHANASIOS I (DDS, MS, DRMSC)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIOS
Middle Name:I
Last Name:ZAVRAS
Suffix:
Gender:M
Credentials:DDS, MS, DRMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2426
Mailing Address - Country:US
Mailing Address - Phone:617-818-0573
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:SUITE PH17W-306
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:617-818-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 - 0559781223P0221X, 1223D0001X
MADN18559221223P0221X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health