Provider Demographics
NPI:1871889022
Name:TZAKAS, STACEY
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:TZAKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5603
Mailing Address - Country:US
Mailing Address - Phone:516-826-3520
Mailing Address - Fax:516-804-5591
Practice Address - Street 1:2085 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5603
Practice Address - Country:US
Practice Address - Phone:516-826-3520
Practice Address - Fax:516-804-5591
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056 335-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice