Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 17494 | TX |
NPI | 1124143698 |
---|---|
Provider Name | Dr. Nicholas Stelios Makrides |
First Address | Manassas, VA 20112-3294 |
Second Address | Washington, DC 20534-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |