Provider Demographics
NPI:1689712671
Name:BACOS, CHRISTOS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOS
Middle Name:J
Last Name:BACOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-454-7254
Mailing Address - Fax:978-458-5467
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-454-7254
Practice Address - Fax:978-458-5467
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX02896OtherBLUE CROSS & BLUE SHIELD
MA009650OtherTUFTS HEALTH PLAN
MA0261343Medicaid
MA16168OtherHARVARD PILGRIM
MA0261343Medicaid
MA16168OtherHARVARD PILGRIM