Provider Demographics
NPI:1205980026
Name:MIGADAKI, EVANTHIA (DMD)
Entity type:Individual
Prefix:DR
First Name:EVANTHIA
Middle Name:
Last Name:MIGADAKI
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 1:29 COOPER ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3819
Mailing Address - Country:US
Mailing Address - Phone:212-567-3368
Mailing Address - Fax:212-567-1941
Practice Address - Street 1:29 COOPER ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3819
Practice Address - Country:US
Practice Address - Phone:212-567-3368
Practice Address - Fax:212-567-1941
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0535221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02735000Medicaid