Provider Demographics
NPI:1386768380
Name:MANOLIS, SOPHIA C (DDS)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:C
Last Name:MANOLIS
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 1:21 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1324
Mailing Address - Country:US
Mailing Address - Phone:631-928-3472
Mailing Address - Fax:
Practice Address - Street 1:602 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2203
Practice Address - Country:US
Practice Address - Phone:631-473-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist