1386800480 NPI number — DR. IRENE COSTARAS-VASILAKIS DDS

Table of content: DR. IRENE COSTARAS-VASILAKIS DDS (NPI 1386800480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386800480 NPI number — DR. IRENE COSTARAS-VASILAKIS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTARAS-VASILAKIS
Provider First Name:
IRENE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386800480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 ROCKSIDE RD
Provider Second Line Business Mailing Address:
ROCKSIDE PLAZA #218
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44134-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-749-4500
Provider Business Mailing Address Fax Number:
216-749-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 ROCKSIDE RD
Provider Second Line Business Practice Location Address:
ROCKSIDE PLAZA #218
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44134-2774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-749-4500
Provider Business Practice Location Address Fax Number:
216-749-5975
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  15879 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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