Provider Demographics
NPI:1659749190
Name:PAPADEMETRIOU, MICHAEL (DMD,MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PAPADEMETRIOU
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 E CHAUNCEY LN STE 245
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3118
Mailing Address - Country:US
Mailing Address - Phone:480-515-0660
Mailing Address - Fax:
Practice Address - Street 1:7010 E CHAUNCEY LN STE 245
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3118
Practice Address - Country:US
Practice Address - Phone:480-515-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD040431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics