Provider Demographics
NPI:1245527381
Name:PEDIATRIC DENTISTRY OF SUFFOLK COUNTY II
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF SUFFOLK COUNTY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:IOANNOU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-320-0880
Mailing Address - Street 1:3237 ROUTE 112
Mailing Address - Street 2:BUILDING #6 SUITE 7B
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1424
Mailing Address - Country:US
Mailing Address - Phone:631-320-0880
Mailing Address - Fax:631-320-3165
Practice Address - Street 1:3237 ROUTE 112
Practice Address - Street 2:BUILDING #6 SUITE 7B
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1424
Practice Address - Country:US
Practice Address - Phone:631-320-0880
Practice Address - Fax:631-320-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty