Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 03764 | NH |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1855325 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 243366 | MA |
NPI | 1386837797 |
---|---|
Provider Name | Dr. Sotirios Diamantis |
First Address | Lowell, MA 01852-1335 |
Second Address | Lowell, MA 01852-1335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 08/06/2011 |