Provider Demographics
NPI:1790575157
Name:DASKALAKIS, MICHAEL ATHANASIOS (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ATHANASIOS
Last Name:DASKALAKIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 LANDMARK WAY UNIT 7
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4190
Mailing Address - Country:US
Mailing Address - Phone:937-999-8172
Mailing Address - Fax:
Practice Address - Street 1:1490 10TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-2349
Practice Address - Country:US
Practice Address - Phone:970-806-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002062841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice