Provider Demographics
NPI:1104959642
Name:GATZONIS, GEORGE VASILIOS (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:VASILIOS
Last Name:GATZONIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2153
Mailing Address - Country:US
Mailing Address - Phone:718-726-3600
Mailing Address - Fax:718-726-9816
Practice Address - Street 1:3316 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2153
Practice Address - Country:US
Practice Address - Phone:718-726-3600
Practice Address - Fax:718-726-9816
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042393-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01196574Medicaid