Provider Demographics
NPI:1114163342
Name:THEANO G. GERANIOTIS, DMD, PC
Entity type:Organization
Organization Name:THEANO G. GERANIOTIS, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEANO
Authorized Official - Middle Name:G
Authorized Official - Last Name:GERANIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-932-9320
Mailing Address - Street 1:800 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6372
Mailing Address - Country:US
Mailing Address - Phone:781-932-9320
Mailing Address - Fax:
Practice Address - Street 1:800 W CUMMINGS PARK
Practice Address - Street 2:SUITE 1050
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6372
Practice Address - Country:US
Practice Address - Phone:781-932-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty