Provider Demographics
NPI:1811380314
Name:DT PERIODONTICS AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:DT PERIODONTICS AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIOKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-343-7322
Mailing Address - Street 1:15 BOND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2016
Mailing Address - Country:US
Mailing Address - Phone:516-487-8240
Mailing Address - Fax:516-482-2544
Practice Address - Street 1:15 BOND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2016
Practice Address - Country:US
Practice Address - Phone:516-487-8240
Practice Address - Fax:516-482-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty