Basic Information
| Provider Information | |||||||||
| NPI: | 1316348154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARAGAKIS | ||||||||
| FirstName: | DIMITRIOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 PACIFIC AVE | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535974550 | ||||||||
| FaxNumber: | 2535974556 | ||||||||
| Practice Location | |||||||||
| Address1: | 10510 GRAVELLY LAKE DR SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984995036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535897188 | ||||||||
| FaxNumber: | 2532844384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE00010514 | WA | Y | Dental Providers | Dentist |
No ID Information.