Provider Demographics
NPI:1477262327
Name:PANAGIOTOU, ARISTEIDIS
Entity Type:Individual
Prefix:
First Name:ARISTEIDIS
Middle Name:
Last Name:PANAGIOTOU
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 1:90 GLENDON PL UNIT F
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6085
Mailing Address - Country:US
Mailing Address - Phone:585-635-8640
Mailing Address - Fax:
Practice Address - Street 1:5051 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2310
Practice Address - Country:US
Practice Address - Phone:815-918-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0340091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty