Provider Demographics
NPI:1710040654
Name:GOUPIOS, CHARALABOS G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARALABOS
Middle Name:G
Last Name:GOUPIOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHARALABOS
Other - Middle Name:
Other - Last Name:GOUPIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:573 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9368
Mailing Address - Country:US
Mailing Address - Phone:801-776-1000
Mailing Address - Fax:801-776-5277
Practice Address - Street 1:573 N 1000 W
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-9368
Practice Address - Country:US
Practice Address - Phone:801-776-1000
Practice Address - Fax:801-776-5277
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT26972299221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT680526791Medicare UPIN