Active NPI
Spiro John Pantzoulas, DMD
- Oral and Maxillofacial Surgery (Dentist)
- Kissimmee, FL
National Provider Identifier
1730397530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- DN17517
- Practice address
- 1096 Cypress Pkwy
Kissimmee, FL 34759-3328 - Phone
- (407) 933-8222
- NPI assigned
- May 18, 2007
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DN17517 | FL | Primary |
Addresses
Primary practice location
1096 Cypress Pkwy
Kissimmee, FL 34759-3328
Mailing address
926 Great Pond Dr Ste 2002
Altamonte Springs, FL 32714-7244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150605002463 | FL | Order and Referring Only - Oral Surgery | 3678894367 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN17517 | FL | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431561600000",
"number": "1730397530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 GREAT POND DR STE 2002",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "327147244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1096 CYPRESS PKWY",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347593328",
"telephone_number": "407-933-8222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANTZOULAS",
"first_name": "SPIRO",
"middle_name": "JOHN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2015-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "FL",
"license": "DN17517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.