Provider Demographics
NPI:1891898748
Name:DEMETROPOULOS, JOHN NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:DEMETROPOULOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:E12875 WYNDING WAY
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:WI
Mailing Address - Zip Code:53561-9599
Mailing Address - Country:US
Mailing Address - Phone:262-312-4752
Mailing Address - Fax:
Practice Address - Street 1:TOMAH VA MEDICAL CENTER
Practice Address - Street 2:500 E. VETERANS STREET
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:608-372-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3177-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice