Provider Demographics
NPI:1215942800
Name:KATSARAS, ARISTOMENIS (DMD)
Entity type:Individual
Prefix:DR
First Name:ARISTOMENIS
Middle Name:
Last Name:KATSARAS
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 1:77 TEMPLE STREET
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:617-323-6757
Mailing Address - Fax:617-327-0010
Practice Address - Street 1:55 BELGRADE AVE
Practice Address - Street 2:DENTAL HEALTH WORKS
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-327-4700
Practice Address - Fax:617-327-0010
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice