Provider Demographics
NPI:1134271687
Name:SPELIOS, LOUIS GREGG
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:GREGG
Last Name:SPELIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:
Other - Last Name:SPELIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1721 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4926
Mailing Address - Country:US
Mailing Address - Phone:305-294-6696
Mailing Address - Fax:
Practice Address - Street 1:1721 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4926
Practice Address - Country:US
Practice Address - Phone:305-294-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117051223G0001X
GADN0126171223G0001X
NC75481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice