Provider Demographics
NPI:1629695853
Name:ELEFTHERAKIS, DEAN (LAC DIPL OM)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:ELEFTHERAKIS
Suffix:
Gender:M
Credentials:LAC DIPL OM
Other - Prefix:
Other - First Name:KONSTANTINE
Other - Middle Name:
Other - Last Name:ELEFTHERAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1340 CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 SUNSET DR.
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18447
Practice Address - Country:US
Practice Address - Phone:570-507-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist