Active NPI
Sotery Mamouzelos
- General Practice Dentistry
- Lewisville, TX
National Provider Identifier
1700945276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21180
- Practice address
- 1288 W Main St
Suite 123
Lewisville, TX 75067-3420 - Phone
- (972) 221-2220
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21180 | TX | Primary |
Addresses
Primary practice location
1288 W Main St
Suite 123
Lewisville, TX 75067-3420
Mailing address
650 International Pkwy
Suite 100
Richardson, TX 75081-6612
Phone (972) 221-2220
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21180 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700945276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 INTERNATIONAL PKWY",
"address_2": "SUITE 100",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750816612",
"telephone_number": "972-221-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1288 W MAIN ST",
"address_2": "SUITE 123",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673420",
"telephone_number": "972-221-2220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMOUZELOS",
"first_name": "SOTERY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "21180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.