Provider Demographics
NPI:1184924789
Name:CHARTZOULAKIS, MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CHARTZOULAKIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2389
Mailing Address - Country:US
Mailing Address - Phone:203-264-8500
Mailing Address - Fax:203-264-8502
Practice Address - Street 1:685 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2389
Practice Address - Country:US
Practice Address - Phone:203-264-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133161223P0700X
NY0523271223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty