Provider Demographics
NPI:1063813343
Name:STAVRINOUDIS, CONSTANTINE
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:STAVRINOUDIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 NORTHERN BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3500
Mailing Address - Country:US
Mailing Address - Phone:516-482-5416
Mailing Address - Fax:
Practice Address - Street 1:2110 NORTHERN BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3500
Practice Address - Country:US
Practice Address - Phone:516-482-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057889122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist