Provider Demographics
NPI:1720724768
Name:GAZIS, YIANNIS ZANNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:YIANNIS
Middle Name:ZANNIS
Last Name:GAZIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1857
Mailing Address - Country:US
Mailing Address - Phone:860-342-4502
Mailing Address - Fax:860-342-5474
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1857
Practice Address - Country:US
Practice Address - Phone:860-342-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist