Provider Demographics
NPI:1689963068
Name:DENTINO, STAMATIOS GEORGE MANOLAKAS (M D)
Entity Type:Individual
Prefix:DR
First Name:STAMATIOS
Middle Name:GEORGE MANOLAKAS
Last Name:DENTINO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:MR
Other - First Name:STAMATIOS
Other - Middle Name:GEORGE
Other - Last Name:DENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5646
Mailing Address - Country:US
Mailing Address - Phone:510-219-7686
Mailing Address - Fax:
Practice Address - Street 1:30 N. 1900 E., RM. 5R-110
Practice Address - Street 2:UNIVERSITY OF UTAH DEPT. OF PSYCHIATRY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2502
Practice Address - Country:US
Practice Address - Phone:801-581-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8405889-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry