| Theodrou Professional Dental Group | |
|
19717 Sherman Way Canoga Park CA 91306 | |
| (818) 709-0090 | |
| (818) 709-6002 |
| Full Name | Theodrou Professional Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 19717 Sherman Way, Canoga Park, California |
| Authorized Official Name and Position | Nikolaos Theodorou (DENTIST PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 8187090090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodrou Professional Dental Group 19717 Sherman Way Canoga Park CA 91306 Ph: (818) 709-0090 | Theodrou Professional Dental Group 19717 Sherman Way Canoga Park CA 91306 Ph: (818) 709-0090 |
| NPI Number | 1225152952 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 03/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225152952 | NPI | - | NPPES |
| G9133901 | Other | CA | DENTICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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