Provider Demographics
NPI:1831392067
Name:STAMPELOS, GUS (DMD)
Entity type:Individual
Prefix:DR
First Name:GUS
Middle Name:
Last Name:STAMPELOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-584-5523
Mailing Address - Fax:631-686-6311
Practice Address - Street 1:331 FIRST AVENUE
Practice Address - Street 2:TOTAL FAMILY DENTISTRY
Practice Address - City:ST JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780
Practice Address - Country:US
Practice Address - Phone:631-584-5523
Practice Address - Fax:631-686-6311
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04391411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice