Provider Demographics
NPI:1750395687
Name:KIRUSIS, CHRISTOS GEORGE (DMD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOS
Middle Name:GEORGE
Last Name:KIRUSIS
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 1:1 PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1103
Mailing Address - Country:US
Mailing Address - Phone:508-835-8890
Mailing Address - Fax:508-835-8960
Practice Address - Street 1:1 PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1103
Practice Address - Country:US
Practice Address - Phone:508-835-8890
Practice Address - Fax:508-835-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17555OtherLICENSE #