Provider Demographics
NPI:1831861004
Name:TZOUMAS, DIONYSIOS JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:DIONYSIOS
Middle Name:JOHN
Last Name:TZOUMAS
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 1:245 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1085
Mailing Address - Country:US
Mailing Address - Phone:475-216-9593
Mailing Address - Fax:
Practice Address - Street 1:245 RANGE RD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1085
Practice Address - Country:US
Practice Address - Phone:475-216-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY122300000XMedicaid