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General NPI Number Information
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NPI Number | 1790415537
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Entity Type | Organization
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Legal Business Name | PANAGIOTA STATHOPOULOU DMD LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 9300 SE 91ST AVE STE 403
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-653-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 SE 91ST AVE STE 403
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-653-2299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PANAGIOTA STATHOPOULOU
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Credential | DMD
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Telephone | 503-653-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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