Healthcare Provider Details

I. General information

NPI: 1770815763
Provider Name (Legal Business Name): DEAN CONSTANTINE VAFIADIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 5TH AVE 14TH FLOOR
NEW YORK NY
10022-3110
US

IV. Provider business mailing address

693 5TH AVE 14TH FLOOR
NEW YORK NY
10022-3110
US

V. Phone/Fax

Practice location:
  • Phone: 212-813-1555
  • Fax:
Mailing address:
  • Phone: 212-813-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN042526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: