Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN 11790 | FL |
NPI | 1144256876 |
---|---|
Provider Name | Thomas Aristides Copulos |
First Address | Boca Raton, FL 33486-2268 |
Second Address | Boca Raton, FL 33486-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |