MEDICARE: GEORGE L. ALISSANDRATOS, D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS 2882	TN

General Provider Information

NPI Number	:	1053472324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE L. ALISSANDRATOS, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	431 NISSAN DR STE 202
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 NISSAN DR STE 202
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:	615-459-4474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE LATTO ALISSANDRATOS
Credential	:	D.D.S.
Telephone Number	:	615-459-4474

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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