Provider Demographics
NPI:1467774240
Name:TOULIATOS, SPERO JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:SPERO
Middle Name:JOHN
Last Name:TOULIATOS
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 1:6425 STAGE RD
Mailing Address - Street 2:#8
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134
Mailing Address - Country:US
Mailing Address - Phone:901-386-2718
Mailing Address - Fax:
Practice Address - Street 1:6425 STAGE RD
Practice Address - Street 2:#8
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-386-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND.S.17561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice