Healthcare Provider Details

I. General information

NPI: 1437951621
Provider Name (Legal Business Name): GEORGINA STAMPELOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 1ST AVE
SAINT JAMES NY
11780-2020
US

IV. Provider business mailing address

331 1ST AVE
SAINT JAMES NY
11780-2020
US

V. Phone/Fax

Practice location:
  • Phone: 631-584-5523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: