Provider Demographics
NPI:1124020649
Name:FIACOS, CONSTANTIN (DMD)
Entity type:Individual
Prefix:MR
First Name:CONSTANTIN
Middle Name:
Last Name:FIACOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7752 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4358
Mailing Address - Country:US
Mailing Address - Phone:954-741-4500
Mailing Address - Fax:954-741-4797
Practice Address - Street 1:7752 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4358
Practice Address - Country:US
Practice Address - Phone:954-741-4500
Practice Address - Fax:954-741-4797
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice