Provider Demographics
NPI:1780779066
Name:SOPHOCLES, MICHAEL GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:SOPHOCLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1610
Mailing Address - Country:US
Mailing Address - Phone:610-644-4080
Mailing Address - Fax:610-651-0127
Practice Address - Street 1:21 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1610
Practice Address - Country:US
Practice Address - Phone:610-644-4080
Practice Address - Fax:610-651-0127
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029418L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist