# DR. PERIKLIS PROUSSAEFS, A PROFESSIONAL DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Santa Paula Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174099113
- **Authorized official:** DR. PERIKLIS PROUSSAEFS DDS, MS (OWNER/CEO/CLINIC DIRECTOR)
- **Authorized official phone:** (805) 676-1611

## Contact information

- **Practice address:** 900 EAST MAIN STREET, SANTA PAULA, CA 93060
- **Practice address phone:** (805) 676-1611
- **Practice address fax:** (805) 676-1521
- **Mailing address:** 900 EAST MAIN STREET, SANTA PAULA, CA 93060
- **Mailing address phone:** (805) 676-1611
- **Mailing address fax:** (805) 676-1521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2018
- **Last updated:** 10/17/2018