Provider Demographics
NPI:1790819985
Name:HARALAMBIDIS, COSMO (DMD)
Entity Type:Individual
Prefix:DR
First Name:COSMO
Middle Name:
Last Name:HARALAMBIDIS
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 1:59 PHENIX AVENUE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-464-4999
Mailing Address - Fax:401-464-8903
Practice Address - Street 1:59 PHENIX AVENUE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4222
Practice Address - Country:US
Practice Address - Phone:401-464-4999
Practice Address - Fax:401-464-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI026661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICH-28352Medicaid
MARI0091OtherBLUE CROSS DENTAL MA
RI100-2666OtherDELTA DENTAL RI
RI8135-3OtherBLUE CROSS DENTAL RI