Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 052327 | NY |
Y | 1223P0700X | Prosthodontist | 13316 | CT |
NPI | 1184924789 |
---|---|
Provider Name | Dr. Maria Chartzoulakis |
First Address | Southbury, CT 06488-2389 |
Second Address | Southbury, CT 06488-2389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 11/01/2022 |