Provider Demographics
NPI:1194875385
Name:DRS ATHANASOULAS & PAPPEY ASSOCIATES IN DENTISTRY IHC
Entity type:Organization
Organization Name:DRS ATHANASOULAS & PAPPEY ASSOCIATES IN DENTISTRY IHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEMETRIUS
Authorized Official - Last Name:ATHANASOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-454-2924
Mailing Address - Street 1:155 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-454-2924
Mailing Address - Fax:978-454-0726
Practice Address - Street 1:155 MARKET STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-454-2924
Practice Address - Fax:978-454-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106091223G0001X
MA154881223G0001X
MA203921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty