Healthcare Provider Details

I. General information

NPI: 1457233074
Provider Name (Legal Business Name): DIONYSIA ILIOPOULOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BELMONT AVE STE 414
BALA CYNWYD PA
19004-1607
US

IV. Provider business mailing address

221 CAMBRIDGE RD
CHERRY HILL NJ
08034-1818
US

V. Phone/Fax

Practice location:
  • Phone: 610-638-7308
  • Fax:
Mailing address:
  • Phone: 609-217-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS045343
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: