Individual
ELENI B TARASIDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10160 SUPERIOR WAY, AMELIA COURT HOUSE, VA 23002-4744
(804) 561-4379
Mailing address
10160 SUPERIOR WAY, AMELIA COURT HOUSE, VA 23002-4744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401415609
VA
Other
Enumeration date
04/26/2016
Last updated
08/03/2017
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