Provider Demographics
NPI:1174544936
Name:ELIOPOULOS, THEANO G (DMD)
Entity type:Individual
Prefix:
First Name:THEANO
Middle Name:G
Last Name:ELIOPOULOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:THEANO
Other - Middle Name:G
Other - Last Name:GERANIOTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:800 WEST CUMMINGS PARK
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-932-9320
Mailing Address - Fax:781-932-0893
Practice Address - Street 1:800 WEST CUMMINGS PARK
Practice Address - Street 2:SUITE 1050
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-932-9320
Practice Address - Fax:781-932-0893
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice