Provider Demographics
NPI:1487793980
Name:CATANZARITIHVLASSIS, RACQUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RACQUEL
Middle Name:
Last Name:CATANZARITIHVLASSIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 KIRKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9679
Mailing Address - Country:US
Mailing Address - Phone:315-463-5627
Mailing Address - Fax:315-437-8342
Practice Address - Street 1:6431 KIRKVILLE RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9679
Practice Address - Country:US
Practice Address - Phone:315-463-5627
Practice Address - Fax:315-437-8342
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047055-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice