Healthcare Provider Details

I. General information

NPI: 1619093275
Provider Name (Legal Business Name): KONSTANTINOS H. CHERPELIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 BELL BLVD
BAYSIDE NY
11361-1602
US

IV. Provider business mailing address

3303 BELL BLVD
BAYSIDE NY
11361-1602
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-4646
  • Fax: 718-428-4656
Mailing address:
  • Phone: 718-224-4646
  • Fax: 718-428-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number041579
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041579
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number041579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: