Provider Demographics
NPI:1700051943
Name:POLITIMI MANTZOURANIS DDS LLC
Entity Type:Organization
Organization Name:POLITIMI MANTZOURANIS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-662-8675
Mailing Address - Street 1:140 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4483
Practice Address - Country:US
Practice Address - Phone:301-662-8675
Practice Address - Fax:301-662-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD81591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285773531OtherNPI INDIVIDUAL NUMBER