Provider Demographics
NPI:1396946042
Name:LOGOTHETIS, DEMETRA DEBBIE (RDH, MS)
Entity type:Individual
Prefix:PROF
First Name:DEMETRA
Middle Name:DEBBIE
Last Name:LOGOTHETIS
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 SAN BERNARDINO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2386
Mailing Address - Country:US
Mailing Address - Phone:505-271-0057
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO DENTAL HYGIENE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4513
Practice Address - Fax:505-272-5584
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH738124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist