Provider Demographics
NPI:1437375250
Name:KAZANIS, DEMETRA CHRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEMETRA
Middle Name:CHRISTINA
Last Name:KAZANIS
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 1:1815 N CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4237
Mailing Address - Country:US
Mailing Address - Phone:248-547-2111
Mailing Address - Fax:249-547-2297
Practice Address - Street 1:1815 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4237
Practice Address - Country:US
Practice Address - Phone:248-547-2111
Practice Address - Fax:249-547-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist