Healthcare Provider Details

I. General information

NPI: 1982901187
Provider Name (Legal Business Name): MARIA TERESA IOANNOU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 154TH ST
WHITESTONE NY
11357-1954
US

IV. Provider business mailing address

1101 154TH ST
WHITESTONE NY
11357-1954
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-6090
  • Fax: 718-504-7500
Mailing address:
  • Phone: 718-559-6090
  • Fax: 718-504-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050794-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: