Healthcare Provider Details

I. General information

NPI: 1629996186
Provider Name (Legal Business Name): ANASTASIOS S. PHOTOPOULOS, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SCOTT BLVD STE 3
SANTA CLARA CA
95050-4555
US

IV. Provider business mailing address

1200 SCOTT BLVD STE 3
SANTA CLARA CA
95050-4555
US

V. Phone/Fax

Practice location:
  • Phone: 408-391-1948
  • Fax:
Mailing address:
  • Phone: 408-391-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ANASTASIOS PHOTOPOULOS
Title or Position: OWNER/CEO
Credential: DDS
Phone: 408-391-1948