Provider Demographics
NPI:1699128264
Name:GEORGE XENAKIS, DDS, PLLC
Entity type:Organization
Organization Name:GEORGE XENAKIS, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-643-0927
Mailing Address - Street 1:24825 NORTHERN BLVD STE 2J
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1280
Mailing Address - Country:US
Mailing Address - Phone:718-279-0007
Mailing Address - Fax:718-340-3804
Practice Address - Street 1:24825 NORTHERN BLVD STE 2J
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1280
Practice Address - Country:US
Practice Address - Phone:718-279-0007
Practice Address - Fax:718-340-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042180261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental