Healthcare Provider Details

I. General information

NPI: 1306172226
Provider Name (Legal Business Name): ALEXANDRA ANTONOPOULOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 BELLONA AVE
TOWSON MD
21204-2022
US

IV. Provider business mailing address

8320 BELLONA AVE
TOWSON MD
21204-2022
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-0005
  • Fax: 410-337-0035
Mailing address:
  • Phone: 410-337-0005
  • Fax: 410-337-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALEXANDRA ANTONOPOULOU
Title or Position: ENDODONTIST
Credential: DDS
Phone: 410-337-0005