Provider Demographics
NPI:1689977571
Name:KIAMOS, KONSTANTINOS THEODORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:THEODORE
Last Name:KIAMOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2840
Mailing Address - Country:US
Mailing Address - Phone:718-777-7023
Mailing Address - Fax:718-777-5334
Practice Address - Street 1:2313 24TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2840
Practice Address - Country:US
Practice Address - Phone:718-777-7023
Practice Address - Fax:718-777-5334
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042960-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice