Provider Demographics
NPI:1912989617
Name:ANGELOPULOS, CHRISTOPHER G (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:G
Last Name:ANGELOPULOS
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 1:115 OAK WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-9544
Mailing Address - Country:US
Mailing Address - Phone:540-828-2312
Mailing Address - Fax:540-828-2857
Practice Address - Street 1:115 OAK WOOD DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-9544
Practice Address - Country:US
Practice Address - Phone:540-828-2312
Practice Address - Fax:540-828-2857
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
236-129OtherANTHEM BC/BS PROVIDER ID
1387486OtherUNITED CONCORDIA PROVIDER