Healthcare Provider Details

I. General information

NPI: 1619472818
Provider Name (Legal Business Name): DIMITRIOS MIHELOGIANNAKIS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ELMWOOD AVE EASTMAN INSTITUTE FOR ORAL HEALTH
ROCHESTER NY
14620
US

IV. Provider business mailing address

60 CRITTENDEN BLVD. APT 427
ROCHESTER NY
14620
US

V. Phone/Fax

Practice location:
  • Phone: 585-642-3379
  • Fax:
Mailing address:
  • Phone: 585-642-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number000088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: