Provider Demographics
NPI:1720285646
Name:GRIGOROPOULOS, MARIOS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIOS
Middle Name:
Last Name:GRIGOROPOULOS
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 1:19655 E COUNTRY CLUB DR
Mailing Address - Street 2:6507
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4803
Mailing Address - Country:US
Mailing Address - Phone:305-450-7085
Mailing Address - Fax:
Practice Address - Street 1:1761 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4111
Practice Address - Country:US
Practice Address - Phone:954-424-5868
Practice Address - Fax:954-424-5832
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00147431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice