Active NPI
Tassos John Sfondouris, DDS,MS
- Periodontics
- Severna Park, MD
National Provider Identifier
1013220524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 14161
- Practice address
- 900 Ritchie Hwy
Suite 103
Severna Park, MD 21146-4142 - Phone
- (410) 647-0200
- Fax
- (410) 315-8456
- NPI assigned
- Jul 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 14161 | MD | Primary |
Addresses
Primary practice location
900 Ritchie Hwy
Suite 103
Severna Park, MD 21146-4142
Mailing address
900 Ritchie Hwy
Suite 103
Severna Park, MD 21146-4142
Phone (410) 647-0200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14161 | MD | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280102400000",
"number": "1013220524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 RITCHIE HWY",
"address_2": "SUITE 103",
"city": "SEVERNA PARK",
"state": "MD",
"postal_code": "211464142",
"telephone_number": "410-647-0200",
"fax_number": "410-315-8456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 RITCHIE HWY",
"address_2": "SUITE 103",
"city": "SEVERNA PARK",
"state": "MD",
"postal_code": "211464142",
"telephone_number": "410-647-0200",
"fax_number": "410-315-8456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SFONDOURIS",
"first_name": "TASSOS",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS,MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-26",
"last_updated": "2010-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MD",
"license": "14161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Severna Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.