Provider Demographics
NPI:1790524643
Name:CHOREFTAKIS, EFSTRATIOS
Entity type:Individual
Prefix:DR
First Name:EFSTRATIOS
Middle Name:
Last Name:CHOREFTAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 7TH AVE S RM 412
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2647 SUPERIOR DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8525
Practice Address - Country:US
Practice Address - Phone:507-288-1338
Practice Address - Fax:507-280-6899
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS2441223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0300XDental ProvidersDentistPeriodontics