Provider Demographics
NPI:1114027620
Name:KIRYAKOS, PETER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:KIRYAKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 CROWN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2907
Mailing Address - Country:US
Mailing Address - Phone:408-268-8424
Mailing Address - Fax:408-268-8425
Practice Address - Street 1:6541 CROWN BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2907
Practice Address - Country:US
Practice Address - Phone:408-268-8424
Practice Address - Fax:408-268-8425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist