MEDICARE: JOHN N. KERIAZES DDS

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	0423571	NY

General Provider Information

NPI Number	:	1083892269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN N. KERIAZES DDS

Provider Business Mailing Address
First Line	:	3110 37TH AVE
Second Line	:	SUITE 305
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2102
Country	:	US
Telephone Number	:	718-728-3262
Fax Number	:	718-786-6823

Provider Business Practice Location Address
First Line	:	3110 37TH AVE
Second Line	:	SUITE 305
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2102
Country	:	US
Telephone Number	:	718-728-3262
Fax Number	:	718-786-6823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	08/28/2014

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