Provider Demographics
NPI:1568839827
Name:KATERINA SIOUTIS DMD, LLC
Entity Type:Organization
Organization Name:KATERINA SIOUTIS DMD, LLC
Other - Org Name:MEDIA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANELLOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-566-3600
Mailing Address - Street 1:415 E BALTIMORE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3538
Mailing Address - Country:US
Mailing Address - Phone:610-566-3600
Mailing Address - Fax:
Practice Address - Street 1:415 E BALTIMORE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3538
Practice Address - Country:US
Practice Address - Phone:610-566-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty