Provider Demographics
NPI:1508932146
Name:KOUZOUNAS, DEMITROULA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:DEMITROULA
Middle Name:
Last Name:KOUZOUNAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 SEASIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-934-1877
Mailing Address - Fax:207-883-1184
Practice Address - Street 1:618 US ROUTE ONE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-3229
Practice Address - Fax:207-883-1184
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist