Organization
JOHN G POULOS DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN G POULOS DDS (OWNER)
(631) 262-0644
Entity
Organization
Contact information
Practice address
22 LAUREL AVE, NORTHPORT, NY 11768-3165
(631) 262-0644
(631) 262-0645
Mailing address
22 LAUREL AVE, NORTHPORT, NY 11768-3165
(631) 262-0644
(631) 262-0645
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
31347
NY
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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