Provider Demographics
NPI:1366590051
Name:TSAMBAZIS, PETER DEMETRIUS (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:DEMETRIUS
Last Name:TSAMBAZIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HANCOX AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3336
Mailing Address - Country:US
Mailing Address - Phone:973-542-8089
Mailing Address - Fax:973-542-8089
Practice Address - Street 1:223 MALLORY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1256
Practice Address - Country:US
Practice Address - Phone:201-332-3358
Practice Address - Fax:201-332-4002
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018218001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics