Provider Demographics
NPI:1609314038
Name:ARISTIDIS PONTIKAS, DMD, MS, PLLC
Entity Type:Organization
Organization Name:ARISTIDIS PONTIKAS, DMD, MS, PLLC
Other - Org Name:PONTIKAS PERIODONTICS AND IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARISTIDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTIKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:623-934-1676
Mailing Address - Street 1:301 E BETHANY HOME RD
Mailing Address - Street 2:SUITE B120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1263
Mailing Address - Country:US
Mailing Address - Phone:623-934-1676
Mailing Address - Fax:623-934-6630
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:SUITE B120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:623-934-1676
Practice Address - Fax:623-934-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental