Provider Demographics
NPI:1598067357
Name:HOMER R TOURKAKIS DDS, PC
Entity Type:Organization
Organization Name:HOMER R TOURKAKIS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOURKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-461-0093
Mailing Address - Street 1:3613 RICHARDSON SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6027
Mailing Address - Country:US
Mailing Address - Phone:636-461-0093
Mailing Address - Fax:636-461-0229
Practice Address - Street 1:3613 RICHARDSON SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6027
Practice Address - Country:US
Practice Address - Phone:636-461-0093
Practice Address - Fax:636-461-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14159261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental