Provider Demographics
NPI:1295915767
Name:MARKOS, THEODORE (DMD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:MARKOS
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 1:549 SEAL PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1817
Mailing Address - Country:US
Mailing Address - Phone:617-909-5459
Mailing Address - Fax:
Practice Address - Street 1:5215 WINDWARD PKWY STE D
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3887
Practice Address - Country:US
Practice Address - Phone:770-222-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0151541223P0221X
GADN0151541223X0400X, 1223X0400X
MA220171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry