Provider Demographics
NPI:1487612347
Name:VASILAKIS, GEORGE J (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:VASILAKIS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 467
Mailing Address - Street 2:BOX 3785
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096
Mailing Address - Country:US
Mailing Address - Phone:0611-705-5804
Mailing Address - Fax:
Practice Address - Street 1:CMR 467
Practice Address - Street 2:BOX 3785
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09096
Practice Address - Country:US
Practice Address - Phone:0611-705-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice