Provider Demographics
NPI:1427497452
Name:LIACOPULOS, ERNEST PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:PETER
Last Name:LIACOPULOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3199
Mailing Address - Country:US
Mailing Address - Phone:508-845-2158
Mailing Address - Fax:
Practice Address - Street 1:500 COLONY RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-4238
Practice Address - Country:US
Practice Address - Phone:978-632-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN17582122300000X
126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No126800000XDental ProvidersDental Assistant