Provider Demographics
NPI:1639192917
Name:VLAHOS, GUS CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:CHRIS
Last Name:VLAHOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-1379
Mailing Address - Country:US
Mailing Address - Phone:540-674-4396
Mailing Address - Fax:540-674-6979
Practice Address - Street 1:5709 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084
Practice Address - Country:US
Practice Address - Phone:540-674-4396
Practice Address - Fax:540-674-6979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA041010057991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice