Provider Demographics
NPI:1295983773
Name:KAPSOU, ANDREA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:KAPSOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CALDWELL ST
Mailing Address - Street 2:APT 107
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1213
Mailing Address - Country:US
Mailing Address - Phone:267-239-7373
Mailing Address - Fax:
Practice Address - Street 1:15 PONDVIEW PL
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1068
Practice Address - Country:US
Practice Address - Phone:978-649-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist