Nikolaos Theodorou, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40029 Issued in CA

Practice address

19717 Sherman Way
Canoga Park, CA 91306

Phone

(818) 709-0090

Fax

(818) 709-6002

NPI assigned

Jun 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1245433283",
    "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": {
        "last_name": "THEODOROU",
        "first_name": "NIKOLAOS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL TREATING PROVIDE",
            "identifier": "D40029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Absolute Recovery Therapeutic Solutions LLC
• The Crossroads Hospice, Inc.
• The Villas at Topanga Terrace
• Theodorou Professional Dental Corp.
• Larisa Theodorou, DDS
• Anil Thomas, LCSW
• Carolina Thompson
• Thuyvan Hoang Tran, DDS,Inc
• Thanuttha Tiensawang, R.N.
• Josue Toc

• General Practice Dentistry in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.