Provider Demographics
NPI:1003438938
Name:STATHOPOULOS, KONSTANTINOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:
Last Name:STATHOPOULOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 147TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3040
Mailing Address - Country:US
Mailing Address - Phone:347-743-1275
Mailing Address - Fax:
Practice Address - Street 1:2925 W 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2501
Practice Address - Country:US
Practice Address - Phone:347-743-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0619341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice