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NPI Code Detail

MEDICARE: DR. PETER CHARLES ANTINOPOULOS DDS

MEDICARE: DR. PETER CHARLES ANTINOPOULOS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0411000049VA

General Provider Information

NPI Number : 1104898006
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER CHARLES ANTINOPOULOS DDS
Provider Business Mailing Address
First Line : 301 VIRGINIA ST UNIT 1413
Second Line :
City : RICHMOND
State : VA
Zip : 23219-4188
Country : US
Telephone Number : 804-297-2210
Fax Number :
Provider Business Practice Location Address
First Line : 520 N 12TH ST
Second Line :
City : RICHMOND
State : VA
Zip : 23298-5064
Country : US
Telephone Number : 804-828-8214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 02/10/2020

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Directions to “ DR. PETER CHARLES ANTINOPOULOS DDS” Practice Location

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