Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 052718 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 240882 | NY |
NPI | 1174681076 |
---|---|
Provider Name | Dr. Tasios G. Vakkas |
First Address | Bronxville, NY 10708-6039 |
Second Address | New Rochelle, NY 10804-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 18/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02802202 | (05) | NY |
02813798 | (05) | NY |