Healthcare Provider Details

I. General information

NPI: 1306472444
Provider Name (Legal Business Name): KONSTANTINOS APOSTOLOPOULOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 11/27/2023
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 CHESTER AVE
CLEVELAND OH
44106-1666
US

IV. Provider business mailing address

2552 KENILWORTH RD
CLEVELAND OH
44106-2442
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-4331
  • Fax:
Mailing address:
  • Phone: 216-507-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberRES.003885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: