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General NPI Number Information
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NPI Number | 1760102628
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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 | 08/31/2022
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 7805 HIGHLAND VILLAGE PL STE G105
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City | SAN DIEGO
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State | CA
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Zip | 92129-5181
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Country | US
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Telephone | 650-922-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 23911 DANZIG BAY
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City | DANA POINT
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State | CA
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Zip | 92629-4407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. STEVEN PAUL THEODOSIS
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Credential |
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Telephone | 847-778-1423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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