Provider Demographics
NPI:1689718751
Name:ANTONOPOULOS VAKOPOULOU, ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:ANTONOPOULOS VAKOPOULOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0701
Mailing Address - Country:US
Mailing Address - Phone:443-983-1136
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:443-512-8703
Practice Address - Fax:410-515-1067
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044437-011223E0200X
MD116981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics