Provider Demographics
NPI:1437198827
Name:TRICHAS, KONSTANTINE
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINE
Middle Name:
Last Name:TRICHAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2317
Mailing Address - Country:US
Mailing Address - Phone:973-746-7771
Mailing Address - Fax:973-746-2177
Practice Address - Street 1:49 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2317
Practice Address - Country:US
Practice Address - Phone:973-746-7771
Practice Address - Fax:973-746-2177
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 196041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice