Provider Demographics
NPI:1659540854
Name:DEMETRIADES, NEOPHYTOS C (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:NEOPHYTOS
Middle Name:C
Last Name:DEMETRIADES
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHRISTOU KELLI LEOFOROS, EMPA
Mailing Address - Street 2:
Mailing Address - City:PAFOS
Mailing Address - State:PAFOS
Mailing Address - Zip Code:8250
Mailing Address - Country:CY
Mailing Address - Phone:857-234-1139
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA95971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery