Yiannis Zannis Gazis, DDS
Individual provider Active NPI Dentist · Portland, CT
NPI 1720724768 · NPPES record last updated Jun 5, 2023
Key facts
- NPI
- 1720724768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 13589 (CT)
- Practice address
- 255 Main St
Portland, CT 06480-1857 - Phone
- (860) 342-4502
- NPI assigned
- May 11, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13589 | CT | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13589 | CT | Yes |
Addresses
Primary practice location
255 Main St
Portland, CT 06480-1857
Mailing address
255 Main St
Portland, CT 06480-1857
Phone (860) 342-4502
Other providers in Portland, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.