Provider Demographics
NPI:1023156841
Name:KATSAROS, THALIA RAMBALAKOS
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:RAMBALAKOS
Last Name:KATSAROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THALIA
Other - Middle Name:
Other - Last Name:RAMBALAKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7863 BROADWAY
Mailing Address - Street 2:SUITE #111
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5553
Mailing Address - Country:US
Mailing Address - Phone:219-769-6636
Mailing Address - Fax:219-769-4396
Practice Address - Street 1:7863 BROADWAY
Practice Address - Street 2:SUITE #111
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:219-769-6636
Practice Address - Fax:219-769-4396
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010239A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry