Provider Demographics
NPI:1205483187
Name:EXARCHOS, ELIAS ARISTIDES (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:ARISTIDES
Last Name:EXARCHOS
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 1:15 WAVERLY ST APT 230
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1243
Mailing Address - Country:US
Mailing Address - Phone:617-930-1988
Mailing Address - Fax:
Practice Address - Street 1:181 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2317
Practice Address - Country:US
Practice Address - Phone:617-492-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty