Provider Demographics
NPI:1982901187
Name:IOANNOU, MARIA TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA TERESA
Middle Name:
Last Name:IOANNOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 154TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1954
Mailing Address - Country:US
Mailing Address - Phone:718-559-6090
Mailing Address - Fax:718-504-7500
Practice Address - Street 1:1101 154TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1954
Practice Address - Country:US
Practice Address - Phone:718-559-6090
Practice Address - Fax:718-504-7500
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050794-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02546367Medicaid