MEDICARE: DR. MICHAEL ANDREW IOANNOU D.M.D.

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	1223P0221X	Pediatric Dentistry	050315	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659362366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANDREW IOANNOU D.M.D.

Provider Business Mailing Address
First Line	:	35 SPRINGWOOD PATH
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-1304
Country	:	US
Telephone Number	:	917-568-4569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 JERICHO TPKE STE 145
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-2900
Country	:	US
Telephone Number	:	631-486-6364
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	10/20/2017

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