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General NPI Number Information
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NPI Number | 1235132192
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Entity Type | Individual
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Provider Name | CONSTANTINE STAMATELAKYS DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 2933 W LAYTON AVE
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City | GREENFIELD
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State | WI
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Zip | 53221-2626
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Country | US
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Telephone | 414-282-2642
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Fax |
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Provider Business Mailing Address
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Address Line | 2933 W LAYTON AVE
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City | GREENFIELD
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State | WI
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Zip | 53221-2626
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Country | US
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Telephone |
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 1847
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License Number State | WI
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