Provider Demographics
NPI:1063555019
Name:KAZOU, THEONI A (DMD)
Entity type:Individual
Prefix:DR
First Name:THEONI
Middle Name:A
Last Name:KAZOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3823
Mailing Address - Country:US
Mailing Address - Phone:617-666-4444
Mailing Address - Fax:617-666-1113
Practice Address - Street 1:402 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3823
Practice Address - Country:US
Practice Address - Phone:617-666-4444
Practice Address - Fax:617-666-1113
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice