Healthcare Provider Details

I. General information

NPI: 1679558472
Provider Name (Legal Business Name): STEVEN MICHAEL DANDALIDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

2349 HAVERSHAM CLOSE
VIRGINIA BEACH VA
23454-1154
US

V. Phone/Fax

Practice location:
  • Phone: 252-413-6260
  • Fax:
Mailing address:
  • Phone: 757-553-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301504154
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number38598
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01086272A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101040588
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: