Healthcare Provider Details

I. General information

NPI: 1982883575
Provider Name (Legal Business Name): VICKI C PETROPOULOS DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 4TH AVE
SAN DIEGO CA
92101-3107
US

IV. Provider business mailing address

PO BOX 7308
RANCHO SANTA FE CA
92067-7308
US

V. Phone/Fax

Practice location:
  • Phone: 619-795-1301
  • Fax:
Mailing address:
  • Phone: 267-342-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS0276299-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number62346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: