Provider Demographics
NPI:1659643989
Name:STEVEN CARADIMOS DMD PC
Entity Type:Organization
Organization Name:STEVEN CARADIMOS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARADIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-771-1777
Mailing Address - Street 1:30 HIGGINS CROWELL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-3444
Mailing Address - Country:US
Mailing Address - Phone:508-771-1777
Mailing Address - Fax:
Practice Address - Street 1:30 HIGGINS CROWELL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3444
Practice Address - Country:US
Practice Address - Phone:508-771-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty