Provider Demographics
NPI:1760659361
Name:ANAGNOSTAKOS, PAUL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:ANAGNOSTAKOS
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 1:4 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4311
Mailing Address - Country:US
Mailing Address - Phone:215-357-4321
Mailing Address - Fax:215-942-7312
Practice Address - Street 1:4 ARBOR LN
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4311
Practice Address - Country:US
Practice Address - Phone:215-357-4321
Practice Address - Fax:215-942-7312
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028253L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist