Provider Demographics
NPI:1972712529
Name:THEODORE N CONSTANDELIS
Entity Type:Organization
Organization Name:THEODORE N CONSTANDELIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CONSTANDELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-684-1078
Mailing Address - Street 1:465 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2234
Mailing Address - Country:US
Mailing Address - Phone:973-684-1078
Mailing Address - Fax:973-278-3128
Practice Address - Street 1:465 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2234
Practice Address - Country:US
Practice Address - Phone:973-684-1078
Practice Address - Fax:973-278-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ110191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty