Provider Demographics
NPI:1689793028
Name:MEREOS, ISIDOROS ARISTIDIS (DDS)
Entity Type:Individual
Prefix:
First Name:ISIDOROS
Middle Name:ARISTIDIS
Last Name:MEREOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ISIDOROS
Other - Middle Name:ARISTIDIS
Other - Last Name:MEREOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2625 COLLINS AVE APT 1708
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4771
Mailing Address - Country:US
Mailing Address - Phone:305-534-1312
Mailing Address - Fax:305-532-1325
Practice Address - Street 1:1315 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3811
Practice Address - Country:US
Practice Address - Phone:305-532-9114
Practice Address - Fax:305-532-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist