Provider Demographics
NPI:1093978819
Name:PANAGOPOULOS, VASSILIS K (DDS)
Entity Type:Individual
Prefix:DR
First Name:VASSILIS
Middle Name:K
Last Name:PANAGOPOULOS
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 1:20855 WATERTOWN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1873
Mailing Address - Country:US
Mailing Address - Phone:262-717-9104
Mailing Address - Fax:262-717-9105
Practice Address - Street 1:20855 WATERTOWN RD STE 120
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1873
Practice Address - Country:US
Practice Address - Phone:262-717-9104
Practice Address - Fax:262-717-9105
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice