Provider Demographics
NPI:1760001440
Name:PATSARIKAS, KONSTANTINE ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINE
Middle Name:ALEXANDER
Last Name:PATSARIKAS
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 1:3696 HEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1135
Mailing Address - Country:US
Mailing Address - Phone:248-563-9331
Mailing Address - Fax:
Practice Address - Street 1:1386 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1349
Practice Address - Country:US
Practice Address - Phone:810-664-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016004821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice