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Provider Information for 1144594441

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NIKOLAS MARIOS STATHOPOULOS D.D.S

Gender: MALE

Individual NPI: 1144594441

Calendar   Last Updated:  2012-03-04
  Certification Date: 

Details

Name Value
NPI 1144594441
Enumeration Date 2012-03-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 19682 HESPERIAN BLVD SUITE 106
HAYWARD, CA 94541-4752
United States

Phone: 510-264-1410 | Fax: 510-264-1406
View Map External Link
Primary Practice Address 19682 HESPERIAN BLVD SUITE 106
HAYWARD, CA 94541-4752
United States

Phone: 510-264-1410 | Fax: 510-264-1406
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 52005