Provider Demographics
NPI:1922586841
Name:DEMOS DENTAL PC
Entity Type:Organization
Organization Name:DEMOS DENTAL PC
Other - Org Name:SUNNY SMILES 4 KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PARASKEVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURTSOUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-451-7700
Mailing Address - Street 1:750 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-727-8585
Mailing Address - Fax:631-727-8589
Practice Address - Street 1:750 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2791
Practice Address - Country:US
Practice Address - Phone:631-727-8585
Practice Address - Fax:631-727-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid