Peter A. Stathoulopoulos, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MS062768OC Issued in MA

Practice address

199 Highland St
Worcester, MA 01609-2231

Phone

(508) 755-7171

Fax

(508) 755-5409

NPI assigned

Jun 7, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285837344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 HIGHLAND ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092231",
            "telephone_number": "508-755-7171",
            "fax_number": "508-755-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 HIGHLAND ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016092231",
            "telephone_number": "508-755-7171",
            "fax_number": "508-755-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHOULOPOULOS",
        "first_name": "PETER",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "MS062768OC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Helen Starek
• Janet Elizabeth Starr
• Jerome I Starr, M.D.
• Tyler Chazan Starr
• Jill Starsiak, MSPT
• Michael P Stauff, M.D.
• Caitlin Paige Stavens-Meucci, NNP
• Zheni Stavre, M.D.
• Jeanne M. Stawiecki, C.R.N.A.
• Suzanne Marie Stead

• General Practice Dentistry in Worcester, MA
• Providers in Worcester, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.