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General NPI Number Information
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NPI Number | 1609019223
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Entity Type | Individual
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Provider Name | ILIAS G ALEVIZOS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 9000 ROCKVILLE PIKE BLDG 10/ROOM 1N110
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-496-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 4242 E WEST HWY APT#610
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City | CHEVY CHASE
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State | MD
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Zip | 20815-5934
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Country | US
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Telephone | 301-496-6207
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19527
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License Number State | MA
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