Healthcare Provider Details

I. General information

NPI: 1346300399
Provider Name (Legal Business Name): DEMETRIOS C PATRINOS DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 WASHINGTON RD SUITE 111
PITTSBURGH PA
15241
US

IV. Provider business mailing address

2585 WASHINGTON RD SUITE 111
PITTSBURGH PA
15241
US

V. Phone/Fax

Practice location:
  • Phone: 412-833-3331
  • Fax: 412-833-2485
Mailing address:
  • Phone: 412-833-3331
  • Fax: 412-833-2485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS028322L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: