Provider Demographics
NPI:1952503252
Name:ATSAVES, DEMETRA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRA
Middle Name:A
Last Name:ATSAVES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 35TH ST
Mailing Address - Street 2:APT. #1-F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1540
Mailing Address - Country:US
Mailing Address - Phone:617-501-3999
Mailing Address - Fax:
Practice Address - Street 1:200 CORPORATE BLVD S
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6806
Practice Address - Country:US
Practice Address - Phone:718-920-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053393-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist