Provider Demographics
NPI:1467605162
Name:STERGAKOS, MILTIADES (DDS)
Entity Type:Individual
Prefix:
First Name:MILTIADES
Middle Name:
Last Name:STERGAKOS
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 1:604 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5644
Mailing Address - Country:US
Mailing Address - Phone:631-225-2115
Mailing Address - Fax:631-225-2010
Practice Address - Street 1:604 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5644
Practice Address - Country:US
Practice Address - Phone:631-225-2115
Practice Address - Fax:631-225-2010
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04880711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice