Dental Board of California
Licensing details for: 45310
Name: PROUSSAEFS, PERIKLIS THEODORE
License Type: Dentist
Primary Status: Current - Active
Address of Record
3585 TELEGRAPH ROAD
SUITE C
VENTURA CA 93003
VENTURA county
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: DR. PERIKLIS PROUSSAEFS, A PROFESSIONAL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79834 Primary Status: Current - Active
Address :
900 EAST MAIN STREET
SANTA PAULA CA 93060
VENTURA COUNTY
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Conscious Sedation Permit
License Number: 708 Primary Status: Cancelled
Address :
3585 TELEGRAPH RD, #C
VENTURA CA 93003
VENTURA COUNTY
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Conscious Sedation Permit
License Number: 388 Primary Status: Cancelled
Address :
310 S Lake Ave
PASADENA CA 91101-3537
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: ENCINO COSMETIC AND IMPLANT DENTAL GROUP,
License/Registration Type: Fictitious Name Permit
License Number: 5814 Primary Status: Cancelled
Address :
16133 VENTURA BLVD, STE 1100
ENCINO CA 91436
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PACIFIC COAST IMPLANT CENTER, DENTAL PRACTICE OF DR. PERIKLIS PRO
License/Registration Type: Fictitious Name Permit
License Number: 11848 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD
SUITE A
VENTURA CA 93003
VENTURA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PACIFIC VIEW DENTAL GROUP, PERIKLIS T. PROUSSAEFS, DDS, MS, A PRO
License/Registration Type: Fictitious Name Permit
License Number: 6417 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD, STE. C
VENTURA CA 93003
VENTURA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: SANTA PAULA DENTAL GROUP DENTAL GROUP OF DR. PERIKLIS PROUSSAEFS,
License/Registration Type: Fictitious Name Permit
License Number: 12387 Primary Status: Current - Active
Address :
900 E. MAIN STREET
SANTA PAULA CA 93060
VENTURA COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: PACIFIC VIEW DENTAL GROUP, PERIKLIS T. PROUSSAEFS, DDS, MS, A PRO
License/Registration Type: Fictitious Name Permit
License Number: 6417 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD, STE. C
VENTURA CA 93003
VENTURA COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: PACIFIC COAST IMPLANT CENTER, DENTAL PRACTICE OF DR. PERIKLIS PRO
License/Registration Type: Fictitious Name Permit
License Number: 11848 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD
SUITE A
VENTURA CA 93003
VENTURA COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: ENCINO COSMETIC AND IMPLANT DENTAL GROUP,
License/Registration Type: Fictitious Name Permit
License Number: 5814 Primary Status: Cancelled
Address :
16133 VENTURA BLVD, STE 1100
ENCINO CA 91436
LOS ANGELES COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: SANTA PAULA DENTAL GROUP DENTAL GROUP OF DR. PERIKLIS PROUSSAEFS,
License/Registration Type: Fictitious Name Permit
License Number: 12387 Primary Status: Current - Active
Address :
900 E. MAIN STREET
SANTA PAULA CA 93060
VENTURA COUNTY
MS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Moderate Sedation Permit
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Moderate Sedation Permit
License Number: 390 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD #C
VENTURA CA 93003
VENTURA COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 1051 Primary Status: Cancelled
Address :
2316 CALLE RISCOSO
THOUSAND OAKS CA 91362
VENTURA COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 2069 Primary Status: Cancelled
Address :
3585 TELEGRAPH RD, #C
VENTURA CA 93003
VENTURA COUNTY
