MEDICARE: DR. KONSTANTINOS H. CHERPELIS 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	332BC3200X	Customized Equipment (DME)	041579	NY
2	1223G0001X	General Practice Dentistry	041579	NY
3	261QM1300X	Multi-Specialty Clinic/Center	041579	NY

General Provider Information

NPI Number	:	1619093275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONSTANTINOS H. CHERPELIS DDS

Provider Business Mailing Address
First Line	:	3303 BELL BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1602
Country	:	US
Telephone Number	:	718-224-4646
Fax Number	:	718-428-4656

Provider Business Practice Location Address
First Line	:	3303 BELL BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1602
Country	:	US
Telephone Number	:	718-224-4646
Fax Number	:	718-428-4656

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/24/2026

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