Provider Demographics
NPI:1619005337
Name:VLAHOS, HARALAMBOS BOB (DMD)
Entity type:Individual
Prefix:DR
First Name:HARALAMBOS
Middle Name:BOB
Last Name:VLAHOS
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 1:2701 NE 14TH STREET CSWY
Mailing Address - Street 2:SUITE#1
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3535
Mailing Address - Country:US
Mailing Address - Phone:954-941-2490
Mailing Address - Fax:954-941-1470
Practice Address - Street 1:2701 NE 14TH STREET CSWY
Practice Address - Street 2:SUITE#1
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3535
Practice Address - Country:US
Practice Address - Phone:954-941-2490
Practice Address - Fax:954-941-1470
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84585OtherBLUE CROSS PROVIDER ID
FL1576740OtherUNITED CONCORDIA PROVIDER