Healthcare Provider Details

I. General information

NPI: 1366437683
Provider Name (Legal Business Name): THALIA K PSILLAKIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 NEWARK POMPTON TPKE
POMPTON PLAINS NJ
07444-1737
US

IV. Provider business mailing address

22 DOREMUS DR
TOWACO NJ
07082-1531
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-0444
  • Fax:
Mailing address:
  • Phone: 201-906-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14358
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: