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General NPI Number Information
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NPI Number | 1255534293
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Entity Type | Individual
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Provider Name | LARISA THEODOROU DDS
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 19717 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91306
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Country | US
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Telephone | 818-709-0090
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Fax | 818-709-6002
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Provider Business Mailing Address
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Address Line | 19717 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91306
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Country | US
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Telephone | 818-709-0090
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Fax | 818-709-6002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42430
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License Number State | CA
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