Healthcare Provider Details

I. General information

NPI: 1982430625
Provider Name (Legal Business Name): ELEFTHERIA IRIS MICHELAKI DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-2998
US

IV. Provider business mailing address

3 FINIKOS STREET
ATHENS GREECE
14564
GR

V. Phone/Fax

Practice location:
  • Phone: 757-240-5711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401419040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: