Provider Demographics
NPI:1396146015
Name:TSARTSIDIS, STELIOS (DMD)
Entity type:Individual
Prefix:DR
First Name:STELIOS
Middle Name:
Last Name:TSARTSIDIS
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 1:194 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2023
Mailing Address - Country:US
Mailing Address - Phone:781-307-5499
Mailing Address - Fax:
Practice Address - Street 1:612 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2552
Practice Address - Country:US
Practice Address - Phone:617-524-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist