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General NPI Number Information
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NPI Number | 1013928845
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Entity Type | Individual
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Provider Name | THOMAS KOUSTIS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 35403 EUCLID AVE SUITE 200
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4568
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Country | US
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Telephone | 440-942-1161
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Fax | 440-918-9625
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Provider Business Mailing Address
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Address Line | 35403 EUCLID AVE SUITE 200
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4568
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Country | US
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Telephone | 440-942-1161
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Fax | 440-918-9625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17514
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License Number State | OH
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