Provider Demographics
NPI:1609057579
Name:SIATRAS, LOUIS T (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:T
Last Name:SIATRAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2002
Mailing Address - Country:US
Mailing Address - Phone:207-799-2116
Mailing Address - Fax:
Practice Address - Street 1:3 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2002
Practice Address - Country:US
Practice Address - Phone:207-799-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist