Provider Demographics
NPI:1508946534
Name:DEMETRIOU, GARY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:DEMETRIOU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-794-0010
Mailing Address - Fax:978-683-3790
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-794-0010
Practice Address - Fax:978-683-3790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16603OtherLICENSE NUMBER