Provider Demographics
NPI:1316167588
Name:TELLIOS, DIMITRIOS S (DMD)
Entity type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:S
Last Name:TELLIOS
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 1:6345 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-7511
Mailing Address - Country:US
Mailing Address - Phone:727-521-1616
Mailing Address - Fax:727-525-1461
Practice Address - Street 1:6345 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-7511
Practice Address - Country:US
Practice Address - Phone:727-521-1616
Practice Address - Fax:727-525-1461
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL124161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice