Provider Demographics
NPI:1477623791
Name:CHRYSOSTOM, DENO STAVROS (DMD)
Entity Type:Individual
Prefix:MR
First Name:DENO
Middle Name:STAVROS
Last Name:CHRYSOSTOM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 PLATT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170
Mailing Address - Country:US
Mailing Address - Phone:803-796-7934
Mailing Address - Fax:803-796-1357
Practice Address - Street 1:3308 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170
Practice Address - Country:US
Practice Address - Phone:803-796-7934
Practice Address - Fax:803-796-1357
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist