Provider Demographics
NPI:1104083765
Name:ZOURDOS, DESPINA MATO (DDS)
Entity type:Individual
Prefix:DR
First Name:DESPINA
Middle Name:MATO
Last Name:ZOURDOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:116
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2502
Mailing Address - Country:US
Mailing Address - Phone:508-478-1555
Mailing Address - Fax:507-478-7105
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:116
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2502
Practice Address - Country:US
Practice Address - Phone:508-478-1555
Practice Address - Fax:507-478-7105
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice