NPIMap

Organization Active NPI

Dr. Periklis Proussaefs, a Professional Dental Corporation

Doing business as Santa Paula Dental Group

  • Dentist
  • Santa Paula, CA
National Provider Identifier
1174099113
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DR. PERIKLIS PROUSSAEFS, A PROFESSIONAL DENTAL CORPORATION
Doing business as
Santa Paula Dental Group
Practice address
900 East Main Street
Santa Paula, CA 93060
Phone
(805) 676-1611
Fax
(805) 676-1521
NPI assigned
Oct 17, 2018
Last updated
Oct 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Periklis Proussaefs, DDS, MSNPI 1316077498
Title
Owner/Ceo/Clinic Director
Phone
(805) 676-1611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

900 East Main Street
Santa Paula, CA 93060

Mailing address

900 East Main Street
Santa Paula, CA 93060
Phone (805) 676-1611

Other names 1

  • Santa Paula Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

900 E Main St
Santa Paula, CA 93060
Phone (805) 676-1611

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1174099113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 EAST MAIN STREET",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "93060",
            "telephone_number": "805-676-1611",
            "fax_number": "805-676-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 EAST MAIN STREET",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "93060",
            "telephone_number": "805-676-1611",
            "fax_number": "805-676-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. PERIKLIS PROUSSAEFS, A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "PROUSSAEFS",
        "authorized_official_first_name": "PERIKLIS",
        "authorized_official_title_or_position": "OWNER/CEO/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "805-676-1611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Paula Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Paula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.