Provider Demographics
NPI:1154349066
Name:MASGALAS, TASSIA DIMITRIOS (DDS)
Entity type:Individual
Prefix:DR
First Name:TASSIA
Middle Name:DIMITRIOS
Last Name:MASGALAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TASSIA
Other - Middle Name:M
Other - Last Name:LABOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:420 WEST ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-632-4164
Mailing Address - Fax:717-632-8987
Practice Address - Street 1:420 WEST ELM AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-632-4164
Practice Address - Fax:717-632-8987
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026937L122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist