Provider Demographics
NPI:1508653874
Name:KANELLOPOULOS, VASILIKI THOMAEE (DMD)
Entity type:Individual
Prefix:
First Name:VASILIKI
Middle Name:THOMAEE
Last Name:KANELLOPOULOS
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 1:44611 LARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4372
Mailing Address - Country:US
Mailing Address - Phone:248-444-4408
Mailing Address - Fax:
Practice Address - Street 1:714 ABBOT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3101
Practice Address - Country:US
Practice Address - Phone:517-337-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program