Provider Demographics
NPI:1790989234
Name:ROULA GIANNOS DMD PC
Entity Type:Organization
Organization Name:ROULA GIANNOS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-236-3381
Mailing Address - Street 1:1 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1919
Mailing Address - Country:US
Mailing Address - Phone:207-236-3381
Mailing Address - Fax:207-236-0705
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1919
Practice Address - Country:US
Practice Address - Phone:207-236-3381
Practice Address - Fax:207-236-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty