P Demetrakopulos DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

P DEMETRAKOPULOS DDS PC

Doing business as

Graton Dental Group

Practice address

1400 Medical Center Dr Ste C
Rohnert Park, CA 94928-2924

Phone

(707) 706-2028

NPI assigned

Jan 21, 2021

Last updated

Jan 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Graton Dental Group Doing business as

Locations

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611187200000",
    "number": "1255921409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MEDICAL CENTER DR STE C",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282924",
            "telephone_number": "707-706-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MEDICAL CENTER DR STE C",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282924",
            "telephone_number": "707-706-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P DEMETRAKOPULOS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graton Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda K Ormiston, PH.D.
• Andrea Orozco, MA
• David E Orr, ATC
• Rona S Oughin
• Bo Ernest Owens, ATC, CSCS
• Estrella Pacheco
• Sonia Padilla-Montero, CMT
• Robin Page, MFT
• Elizabeth Pak
• Helentina Pang, PHARM.D.

• General Practice Dentistry in Rohnert Park, CA
• Providers in Rohnert 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 Jan 21, 2021; 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.