Provider Demographics
NPI:1619038403
Name:FRANTZIS, THEDOSIOS
Entity Type:Individual
Prefix:
First Name:THEDOSIOS
Middle Name:
Last Name:FRANTZIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10500 ULMERTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3544
Practice Address - Country:US
Practice Address - Phone:727-581-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN40901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics