Provider Demographics
NPI:1316022288
Name:ELIOPOULOS, PETER ANGELO (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANGELO
Last Name:ELIOPOULOS
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 1:227 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2305
Mailing Address - Country:US
Mailing Address - Phone:978-256-9838
Mailing Address - Fax:978-825-6443
Practice Address - Street 1:227 CHELMSFORD STREET
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2305
Practice Address - Country:US
Practice Address - Phone:978-256-9838
Practice Address - Fax:978-825-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist