Provider Demographics
NPI:1336204882
Name:SCORDAKIS, PETER GEORGE (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GEORGE
Last Name:SCORDAKIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 KIEFER BLVD
Mailing Address - Street 2:#1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5418
Mailing Address - Country:US
Mailing Address - Phone:916-363-2374
Mailing Address - Fax:
Practice Address - Street 1:9216 KIEFER BLVD
Practice Address - Street 2:#1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5418
Practice Address - Country:US
Practice Address - Phone:916-363-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice