Provider Demographics
NPI:1841337557
Name:BROKALAKIS, EUGENIA (BSC DDS)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:BROKALAKIS
Suffix:
Gender:F
Credentials:BSC DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 TROUP CRESCENT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8R0A5
Mailing Address - Country:CA
Mailing Address - Phone:519-818-9110
Mailing Address - Fax:
Practice Address - Street 1:13205 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6302
Practice Address - Country:US
Practice Address - Phone:586-977-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist