Provider Demographics
NPI:1326083148
Name:DASSOPOULOS, THEMISTOCLES (MD)
Entity Type:Individual
Prefix:DR
First Name:THEMISTOCLES
Middle Name:
Last Name:DASSOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH STREET
Mailing Address - Street 2:SUITE 640
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:469-800-7180
Mailing Address - Fax:469-800-7190
Practice Address - Street 1:3409 WORTH STREET
Practice Address - Street 2:SUITE 640
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:469-800-7180
Practice Address - Fax:469-800-7190
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008001013207RG0100X
TXQ0899207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760488936OtherGROUP NPI
TX3445801-01Medicaid
TX7310099OtherAETNA MEDICARE