Active NPI
Sotirios Tetradis, DDS
- Oral and Maxillofacial Radiology Dentistry
- Los Angeles, CA
National Provider Identifier
1538247754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Radiology Dentistry
- License
- SP-199
- Practice address
- 10833 Le Conte Ave
CHS 10-165
Los Angeles, CA 90095-1668 - Phone
- (310) 825-5634
- Fax
- (310) 206-2748
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Radiology Dentistry | 1223X0008X | SP-199 | CA | Primary |
Addresses
Primary practice location
10833 Le Conte Ave
CHS 10-165
Los Angeles, CA 90095-1668
Mailing address
10833 Le Conte Ave
CHS 10-165
Los Angeles, CA 90095-1668
Phone (310) 825-5634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-199 | CA | MD | Oral and Maxillofacial Radiology Dentist |
| 199 | CA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538247754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE",
"address_2": "CHS 10-165",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951668",
"telephone_number": "310-825-5634",
"fax_number": "310-206-2748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10833 LE CONTE AVE",
"address_2": "CHS 10-165",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951668",
"telephone_number": "310-825-5634",
"fax_number": "310-206-2748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETRADIS",
"first_name": "SOTIRIOS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0008X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Radiology",
"state": "CA",
"license": "SP-199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.