Provider Demographics
NPI:1285773531
Name:MANTZOURANIS, POLITIMI C (DDS)
Entity type:Individual
Prefix:
First Name:POLITIMI
Middle Name:C
Last Name:MANTZOURANIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-662-8675
Mailing Address - Fax:301-662-8975
Practice Address - Street 1:140 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-662-8675
Practice Address - Fax:301-662-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD081591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice