Individual
DR. PETER J THEODOROU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
2800 WILLIAM D TATE AVE STE 100, GRAPEVINE, TX 76051-4325
(817) 562-2222
Mailing address
2800 WILLIAM D TATE AVE STE 100, GRAPEVINE, TX 76051-4325
(817) 562-2222
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
050920
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
103444
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
37106
TX
Other
Enumeration date
03/15/2007
Last updated
11/12/2021
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