Provider Demographics
NPI:1386837797
Name:DIAMANTIS, SOTIRIOS (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:SOTIRIOS
Middle Name:
Last Name:DIAMANTIS
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:405
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1335
Mailing Address - Country:US
Mailing Address - Phone:978-458-1264
Mailing Address - Fax:978-458-8994
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:405
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1335
Practice Address - Country:US
Practice Address - Phone:978-458-1264
Practice Address - Fax:978-458-8994
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243366204E00000X
MADN18553251223S0112X
NH037641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery