Individual
DR. CHRISTOS KOUMOUTSEAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1417DORCHESTER AVE, BOSTON, MA 02122
(617) 929-4300
Mailing address
1417 DORCHESTER AVE, DORCHESTER, MA 02122-2915
(617) 929-4300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17622
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2177598
—
MA
Enumeration date
03/30/2007
Last updated
07/09/2007
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