Provider Demographics
NPI:1023438355
Name:DIMITRIOS J. VARELDZIS DDS PC
Entity type:Organization
Organization Name:DIMITRIOS J. VARELDZIS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:VARELDZIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-261-9616
Mailing Address - Street 1:737 GOLF VIEW DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9653
Mailing Address - Country:US
Mailing Address - Phone:541-779-4196
Mailing Address - Fax:541-779-4196
Practice Address - Street 1:737 GOLF VIEW DR UNIT A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9653
Practice Address - Country:US
Practice Address - Phone:541-779-4196
Practice Address - Fax:541-779-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty