| Steven P. Theodosis Dental Corporation | |
|
11515 El Camino Real Ste 160 San Diego CA 92130-3037 | |
| (858) 500-5711 | |
| Not Available |
| Full Name | Steven P. Theodosis Dental Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 11515 El Camino Real Ste 160, San Diego, California |
| Authorized Official Name and Position | Steven Paul Theodosis (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8477781423 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Steven P. Theodosis Dental Corporation 23911 Danzig Bay Dana Point CA 92629-4407 Ph: () - | Steven P. Theodosis Dental Corporation 11515 El Camino Real Ste 160 San Diego CA 92130-3037 Ph: (858) 500-5711 |
| NPI Number | 1346960218 |
|---|---|
| Provider Enumeration Date | 08/31/2022 |
| Last Update Date | 12/26/2022 |
| Medicare PECOS PAC ID | 5698151363 |
|---|---|
| Medicare Enrollment ID | O20221004000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346960218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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