Individual
STEPHEN YALLOURAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W STONE DR, STE 1A, KINGSPORT, TN 37660-3256
(423) 246-8211
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS7016
TN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD24477
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3075591
—
TN
05
—
7322721
—
VA
Enumeration date
06/09/2005
Last updated
09/24/2009
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