MEDICARE: KATERINA SIOUTIS DMD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	124Q00000X	Dental Hygienist
2	126800000X	Dental Assistant
3	122300000X	Dentist

General Provider Information

NPI Number	:	1568839827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATERINA SIOUTIS DMD, LLC

Provider Business Mailing Address
First Line	:	415 E BALTIMORE AVE STE 2
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-3538
Country	:	US
Telephone Number	:	610-566-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 E BALTIMORE AVE STE 2
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-3538
Country	:	US
Telephone Number	:	610-566-3600
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. DEAN KANELLOPOULOS
Credential	:
Telephone Number	:	610-566-3600

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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