NPIMap

Organization Active NPI

Demetrios G. Pourlos, DDS, PA

  • General Practice Dentistry
  • Charlotte, NC
National Provider Identifier
1174552319
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5324 Issued in NC
Legal business name
DEMETRIOS G. POURLOS, DDS, PA
Practice address
7251 Pineville Matthews Rd
Suite 100
Charlotte, NC 28226-6158
Phone
(704) 542-6533
Fax
(704) 540-1849
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Demetrios George Pourlos, D.D.S.
Title
Owner
Phone
(704) 542-6533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5324 NC Primary

Addresses

Primary practice location

7251 Pineville Matthews Rd
Suite 100
Charlotte, NC 28226-6158

Mailing address

7251 Pineville Matthews Rd
Suite 100
Charlotte, NC 28226-6158
Phone (704) 542-6533

Other identifiers 1

IdentifierTypeStateIssuer
97025OtherNCBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174552319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7251 PINEVILLE MATTHEWS RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282266158",
            "telephone_number": "704-542-6533",
            "fax_number": "704-540-1849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7251 PINEVILLE MATTHEWS RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282266158",
            "telephone_number": "704-542-6533",
            "fax_number": "704-540-1849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEMETRIOS G. POURLOS, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POURLOS",
        "authorized_official_first_name": "DEMETRIOS",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-542-6533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "97025",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.