Provider Demographics
NPI:1972714376
Name:POULOS, CHRIS MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:MICHAEL
Last Name:POULOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BABICZ RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2501
Mailing Address - Country:US
Mailing Address - Phone:617-312-2066
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER PLACE
Practice Address - Street 2:DRS JOHN BOSS & CHRISTOPHER POULOS
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-458-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice