Theodorou Professional Dental Corp.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

THEODOROU PROFESSIONAL DENTAL CORP.

Practice address

19717 Sherman Way
Canoga Park, CA 91306

Phone

(818) 709-0090

Fax

(818) 709-6002

NPI assigned

Mar 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Nikolaos Theodorou, DDS

Title

Dentist President of Corporation

Phone

(818) 709-0090

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Theodrou Professional Dental Group Other name

Locations

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1225152952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19717 SHERMAN WAY",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "91306",
            "telephone_number": "818-709-0090",
            "fax_number": "818-709-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19717 SHERMAN WAY",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "91306",
            "telephone_number": "818-709-0090",
            "fax_number": "818-709-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODOROU PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "THEODOROU",
        "authorized_official_first_name": "NIKOLAOS",
        "authorized_official_title_or_position": "DENTIST PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "818-709-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G9133901",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theodrou Professional Dental Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Theodrou Professional Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.