Provider Demographics
NPI:1639264823
Name:PAPADOPOULOS, HRISOULA D (DMD)
Entity Type:Individual
Prefix:DR
First Name:HRISOULA
Middle Name:D
Last Name:PAPADOPOULOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HRISOULA
Other - Middle Name:D
Other - Last Name:PAPADOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:34 LIVINGSTON ST
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4713
Practice Address - Country:US
Practice Address - Phone:845-240-7860
Practice Address - Fax:845-471-2579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045263-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02653616Medicaid