Provider Demographics
NPI:1760994347
Name:VASOS ERACLEOUS, DDS
Entity Type:Organization
Organization Name:VASOS ERACLEOUS, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VASOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERACLEOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-728-5759
Mailing Address - Street 1:2917 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1741
Mailing Address - Country:US
Mailing Address - Phone:718-728-5759
Mailing Address - Fax:718-204-8786
Practice Address - Street 1:2917 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1741
Practice Address - Country:US
Practice Address - Phone:718-728-5759
Practice Address - Fax:718-204-8786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASOS ERACLEOUS, DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50191261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental