Provider Demographics
NPI:1316111008
Name:DEMETRIOS PATRINOS DMD MD PC
Entity type:Organization
Organization Name:DEMETRIOS PATRINOS DMD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATRINOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:412-833-3331
Mailing Address - Street 1:2585 WASHINGTON RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2565
Mailing Address - Country:US
Mailing Address - Phone:412-833-3331
Mailing Address - Fax:412-833-2485
Practice Address - Street 1:2585 WASHINGTON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2565
Practice Address - Country:US
Practice Address - Phone:412-833-3331
Practice Address - Fax:412-833-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028322L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026964Medicare PIN