Provider Demographics
NPI:1518079995
Name:ANASTASIA THEODOROU D.M.D. , P.A.
Entity Type:Organization
Organization Name:ANASTASIA THEODOROU D.M.D. , P.A.
Other - Org Name:GREAT FALLS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-356-2089
Mailing Address - Street 1:19111 DETROIT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1740
Mailing Address - Country:US
Mailing Address - Phone:440-356-2089
Mailing Address - Fax:440-356-2090
Practice Address - Street 1:2 GREAT FALLS PLZ
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5966
Practice Address - Country:US
Practice Address - Phone:207-784-4222
Practice Address - Fax:207-784-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty