Provider Demographics
NPI:1861840472
Name:VLASSOPOULOS, CONSTANTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:VLASSOPOULOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KERASOUNTOS STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:ATTICA
Mailing Address - Zip Code:11528
Mailing Address - Country:GR
Mailing Address - Phone:301210-777-3423
Mailing Address - Fax:
Practice Address - Street 1:11 WINNERS CIR
Practice Address - Street 2:ASPEN DENTAL
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1727
Practice Address - Country:US
Practice Address - Phone:207-725-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN44711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice