Provider Demographics
NPI:1821304023
Name:BALAOURAS, SPIRO KONSTANTINO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPIRO
Middle Name:KONSTANTINO
Last Name:BALAOURAS
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 1:200 CENTRAL PARK S
Mailing Address - Street 2:SUITE #206
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1436
Mailing Address - Country:US
Mailing Address - Phone:212-247-4194
Mailing Address - Fax:212-262-2990
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:SUITE #206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1436
Practice Address - Country:US
Practice Address - Phone:212-247-4194
Practice Address - Fax:212-262-2990
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice