Provider Demographics
NPI:1851480578
Name:DIAKOGIANNIS, MARIELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIELENA
Middle Name:
Last Name:DIAKOGIANNIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MARIELENA
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:16032 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3905
Mailing Address - Country:US
Mailing Address - Phone:718-423-4500
Mailing Address - Fax:718-423-5268
Practice Address - Street 1:16032 20TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3905
Practice Address - Country:US
Practice Address - Phone:718-423-4500
Practice Address - Fax:718-423-5268
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics