Provider Demographics
NPI:1497078562
Name:KATSOUGRAKIS, ATHINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATHINA
Middle Name:
Last Name:KATSOUGRAKIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2293
Mailing Address - Country:US
Mailing Address - Phone:631-271-9199
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-271-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053943-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice