Provider Demographics
NPI:1982883575
Name:PETROPOULOS, VICKI C (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:C
Last Name:PETROPOULOS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7308
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-7308
Mailing Address - Country:US
Mailing Address - Phone:267-342-0372
Mailing Address - Fax:
Practice Address - Street 1:1525 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3107
Practice Address - Country:US
Practice Address - Phone:619-795-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0276299-L1223P0700X
CA623461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics