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General NPI Number Information
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NPI Number | 1144956293
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Entity Type | Organization
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Legal Business Name | STEVEN P. THEODOSIS DENTAL CORPORATION
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 27131 CALLE ARROYO STE 203
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2700
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Country | US
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Telephone | 775-762-9455
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Fax |
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Provider Business Mailing Address
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Address Line | 27131 CALLE ARROYO STE 203
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2700
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Country | US
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Telephone | 775-762-9455
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Fax | 858-724-3596
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Authorized Official
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Title or Position | DIRECTOR
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Name | PATRICIA SMITH
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Credential | RDH
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Telephone | 775-762-9455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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