Provider Demographics
NPI:1457472466
Name:MIHALOS, DEMETRIOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:
Last Name:MIHALOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 BIRCH HL
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1001
Mailing Address - Country:US
Mailing Address - Phone:917-647-5180
Mailing Address - Fax:
Practice Address - Street 1:350 5TH AVENUE
Practice Address - Street 2:SUITE 1525
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:212-279-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice