Provider Demographics
NPI:1760601520
Name:MOULINOS, SOTIRIOS SAM (DMD)
Entity Type:Individual
Prefix:
First Name:SOTIRIOS
Middle Name:SAM
Last Name:MOULINOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BAY DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:305-866-4105
Mailing Address - Fax:
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-963-3706
Practice Address - Fax:954-963-1223
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist