Healthcare Provider Details

I. General information

NPI: 1659599199
Provider Name (Legal Business Name): ERIC JON PLOUMIS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 STOCKHOLM ST
BROOKLYN NY
11237-3902
US

IV. Provider business mailing address

453 2ND AVE
NEW YORK NY
10010-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-366-3941
  • Fax:
Mailing address:
  • Phone: 212-685-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number38043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: