Provider Demographics
NPI:1487789988
Name:BREDOLOGOS, STELIANOS ALEXANDROS (DDS)
Entity type:Individual
Prefix:DR
First Name:STELIANOS
Middle Name:ALEXANDROS
Last Name:BREDOLOGOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 LASKIN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4283
Mailing Address - Country:US
Mailing Address - Phone:757-425-1828
Mailing Address - Fax:757-425-1834
Practice Address - Street 1:1917 LASKIN RD STE 106
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4283
Practice Address - Country:US
Practice Address - Phone:757-425-1828
Practice Address - Fax:757-425-1834
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice