Provider Demographics
NPI:1932328382
Name:PAPADOPOULOS, DIMITRI (DIMITRI PAPADOPOULOS)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:
Last Name:PAPADOPOULOS
Suffix:
Gender:M
Credentials:DIMITRI PAPADOPOULOS
Other - Prefix:DR
Other - First Name:DIMITRI
Other - Middle Name:
Other - Last Name:PAPADOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3161 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2801
Mailing Address - Country:US
Mailing Address - Phone:718-777-3116
Mailing Address - Fax:
Practice Address - Street 1:2169 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1405
Practice Address - Country:US
Practice Address - Phone:718-597-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594118Medicaid