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Organization
THEODOROU PROFESSIONAL DENTAL CORP.
Active
Organization
THEODOROU PROFESSIONAL DENTAL CORP.
Active
Other names
Theodrou Professional Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKOLAOS THEODOROU DDS (DENTIST PRESIDENT OF CORPORATION)
(818) 709-0090
Entity
Organization
Contact information
Practice address
19717 SHERMAN WAY, CANOGA PARK, CA 91306
(818) 709-0090
(818) 709-6002
Mailing address
19717 SHERMAN WAY, CANOGA PARK, CA 91306
(818) 709-0090
(818) 709-6002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9133901
DENTICAL
CA
Enumeration date
03/19/2007
Last updated
03/17/2020
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