Provider Demographics
NPI:1538732763
Name:TSATSOS, THEODORA C (DDS)
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:C
Last Name:TSATSOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 DAVIS ST APT 1706
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4254
Mailing Address - Country:US
Mailing Address - Phone:973-979-5540
Mailing Address - Fax:
Practice Address - Street 1:9800 N LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-6068
Practice Address - Country:US
Practice Address - Phone:512-337-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist