Provider Demographics
NPI:1528104171
Name:DESPOTIS, VASSILINA Z (DDS)
Entity type:Individual
Prefix:DR
First Name:VASSILINA
Middle Name:Z
Last Name:DESPOTIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13128 LEBLANC
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3028
Mailing Address - Country:US
Mailing Address - Phone:734-667-1272
Mailing Address - Fax:
Practice Address - Street 1:3276 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2322
Practice Address - Country:US
Practice Address - Phone:734-676-4744
Practice Address - Fax:734-676-3641
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID181960OtherBLUE CROSS BLUE SHIELD MI
MI1384454OtherUNITED CONCORDIA