Provider Demographics
NPI:1316665904
Name:MARIE DOULAVERAKIS DDS INC.
Entity type:Organization
Organization Name:MARIE DOULAVERAKIS DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOULAVERAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDA
Authorized Official - Phone:917-742-4796
Mailing Address - Street 1:5828 ADENMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1002
Mailing Address - Country:US
Mailing Address - Phone:562-867-2612
Mailing Address - Fax:562-210-5255
Practice Address - Street 1:5828 ADENMOOR AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1002
Practice Address - Country:US
Practice Address - Phone:562-867-2612
Practice Address - Fax:562-210-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty