Provider Demographics
NPI:1750070355
Name:BACOULIS, MARKELL (RDH)
Entity type:Individual
Prefix:
First Name:MARKELL
Middle Name:
Last Name:BACOULIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2126
Mailing Address - Country:US
Mailing Address - Phone:203-610-7104
Mailing Address - Fax:
Practice Address - Street 1:735 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5238
Practice Address - Country:US
Practice Address - Phone:914-261-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist