Provider Demographics
NPI:1891359584
Name:MASTRONIKOLAS, STAUROS (DDS, MSC)
Entity type:Individual
Prefix:DR
First Name:STAUROS
Middle Name:
Last Name:MASTRONIKOLAS
Suffix:
Gender:M
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JUMEIRAH BEACH ROAD, JUM 3, VILLA 446
Mailing Address - Street 2:
Mailing Address - City:DUBAI
Mailing Address - State:UNITED ARABS EMIRATES
Mailing Address - Zip Code:00000
Mailing Address - Country:AE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JUMEIRAH BEACH ROAD, JUM 3, VILLA 446
Practice Address - Street 2:
Practice Address - City:DUBAI
Practice Address - State:UNITED ARABS EMIRATES
Practice Address - Zip Code:00000
Practice Address - Country:AE
Practice Address - Phone:009-715-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0261171223P0300X
NY052262-11223P0300X
CODEN.002039011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics