Provider Demographics
NPI:1558534529
Name:MICHAEL N TRAHOS DDS LTD
Entity type:Organization
Organization Name:MICHAEL N TRAHOS DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOSS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-633-2171
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:MICHAEL N TRAHOS DDS LTD
Mailing Address - City:MILFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22514
Mailing Address - Country:US
Mailing Address - Phone:804-633-2171
Mailing Address - Fax:
Practice Address - Street 1:18204 SPARTA RD
Practice Address - Street 2:MICHAEL N TRAHOS DDS LTD
Practice Address - City:MILFORD
Practice Address - State:VA
Practice Address - Zip Code:22514
Practice Address - Country:US
Practice Address - Phone:804-633-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty