Provider Demographics
NPI:1487859070
Name:MERKOURIOU, IOANNIS G (DMD)
Entity Type:Individual
Prefix:DR
First Name:IOANNIS
Middle Name:G
Last Name:MERKOURIOU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:G
Other - Last Name:MERKOURIOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:536 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3018
Mailing Address - Country:US
Mailing Address - Phone:860-296-6224
Mailing Address - Fax:860-296-2337
Practice Address - Street 1:536 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3018
Practice Address - Country:US
Practice Address - Phone:860-296-6224
Practice Address - Fax:860-296-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice