Provider Demographics
NPI:1851475818
Name:CHRISTOLIAS, CONSTANTINE G (DDS DOCTOR OF DENTIS)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:G
Last Name:CHRISTOLIAS
Suffix:
Gender:M
Credentials:DDS DOCTOR OF DENTIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-941-5800
Mailing Address - Fax:201-941-6302
Practice Address - Street 1:608 ANDERSON AV
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-941-5800
Practice Address - Fax:201-941-6302
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101307400122300000X
NY0356441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0614Medicare UPIN