Provider Demographics
NPI:1043870561
Name:RAPTOPOULOS, MICHAIL
Entity type:Individual
Prefix:
First Name:MICHAIL
Middle Name:
Last Name:RAPTOPOULOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 OAK ST SE APT 504
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2962
Mailing Address - Country:US
Mailing Address - Phone:651-352-3143
Mailing Address - Fax:
Practice Address - Street 1:515 DELAWARE ST. SE
Practice Address - Street 2:7-368 MOOS TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist