Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12010239A | IN |
NPI | 1023156841 |
---|---|
Provider Name | Thalia Rambalakos Katsaros |
First Address | Merrillville, IN 46410-5553 |
Second Address | Merrillville, IN 46410-5553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |