Individual
CONSTANTINA BACOPOULOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
141 FRANKLIN ST, STAMFORD, CT 06901-1014
(203) 969-0802
(203) 357-0162
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
054899
NY
1223G0001X
General Practice Dentistry
Primary
010413
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236354
—
CT
Enumeration date
10/11/2007
Last updated
02/07/2011
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