Healthcare Provider Details

I. General information

NPI: 1467365825
Provider Name (Legal Business Name): NIKOLAS M STATHOPOULOS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 SAN RAMON VALLEY BLVD STE 103
SAN RAMON CA
94583-1597
US

IV. Provider business mailing address

2355 SAN RAMON VALLEY BLVD STE 103
SAN RAMON CA
94583-1597
US

V. Phone/Fax

Practice location:
  • Phone: 925-718-8483
  • Fax: 925-854-2207
Mailing address:
  • Phone: 925-718-8483
  • Fax: 925-854-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NIKOLAS STATHOPOULOS
Title or Position: OWNER
Credential: DDS
Phone: 415-377-7876