Provider Demographics
NPI:1427087519
Name:PANAGOS-STATHIS, OLGA (DDS)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:PANAGOS-STATHIS
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 1:18501 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3224
Mailing Address - Country:US
Mailing Address - Phone:313-882-9729
Mailing Address - Fax:313-882-5117
Practice Address - Street 1:18501 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3224
Practice Address - Country:US
Practice Address - Phone:313-882-9729
Practice Address - Fax:313-882-5117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13287331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice