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General NPI Number Information
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NPI Number | 1659362366
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Entity Type | Individual
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Provider Name | MICHAEL ANDREW IOANNOU D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 2171 JERICHO TPKE STE 145
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City | COMMACK
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State | NY
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Zip | 11725-2900
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Country | US
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Telephone | 631-486-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SPRINGWOOD PATH
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City | SYOSSET
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State | NY
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Zip | 11791-1304
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Country | US
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Telephone | 917-568-4569
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 050315
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License Number State | NY
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