Provider Demographics
NPI:1306982889
Name:GERMANAKOS, ANGELA (DDS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GERMANAKOS
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 1:436 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2817
Mailing Address - Country:US
Mailing Address - Phone:516-316-0935
Mailing Address - Fax:718-746-3082
Practice Address - Street 1:14921 14TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1729
Practice Address - Country:US
Practice Address - Phone:718-746-1415
Practice Address - Fax:718-746-3082
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4340411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice