Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 19177 | TX |
NPI | 1003080466 |
---|---|
Provider Name | Anthoula Tzannetoulakou |
First Address | El Paso, TX 79936-5617 |
Second Address | El Paso, TX 79936-5617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/04/2008 |