Provider Demographics
NPI:1013175421
Name:DOUMOURAS, MICHAEL A (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DOUMOURAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 OAK ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5316
Mailing Address - Country:US
Mailing Address - Phone:203-325-4700
Mailing Address - Fax:203-327-7832
Practice Address - Street 1:47 OAK ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5316
Practice Address - Country:US
Practice Address - Phone:203-325-4700
Practice Address - Fax:203-327-7832
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice