Provider Demographics
NPI:1780740282
Name:YAKOUMATOS, JOHN GERASIMOS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERASIMOS
Last Name:YAKOUMATOS
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 1:2427 SAINT ALBERT TER
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-3258
Mailing Address - Country:US
Mailing Address - Phone:240-938-0166
Mailing Address - Fax:
Practice Address - Street 1:19375 CONNECTICUT AVE
Practice Address - Street 2:300
Practice Address - City:SILVER SPRING
Practice Address - State:MP
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-871-8002
Practice Address - Fax:301-871-8429
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist