Provider Demographics
NPI:1790970374
Name:GIANNOUTSOS, EFSTATHIOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:EFSTATHIOS
Middle Name:
Last Name:GIANNOUTSOS
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 1:2161 46TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1333
Mailing Address - Country:US
Mailing Address - Phone:917-518-9128
Mailing Address - Fax:
Practice Address - Street 1:2161 46TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1333
Practice Address - Country:US
Practice Address - Phone:917-518-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics