Provider Demographics
NPI:1396285789
Name:GEORGE TSANGAROULIS DDS PC
Entity type:Organization
Organization Name:GEORGE TSANGAROULIS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSANGAROULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-869-4755
Mailing Address - Street 1:4 DEARFIELD DR STE G-2
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:203-869-4755
Mailing Address - Fax:203-869-1562
Practice Address - Street 1:4 DEARFIELD DR STE G-2
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:203-869-4755
Practice Address - Fax:203-869-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1306046412Medicare NSC