Dental Board of California
Licensing details for: 2069
Name: PROUSSAEFS, PERIKLIS THEODORE
License Type: Oral Conscious Sedation
Primary Status: Cancelled
Specialty: Minor
Address of Record
3585 TELEGRAPH RD, #C
VENTURA CA 93003
VENTURA county
Map
License Relationships
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: 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 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
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Dentist License
License Number: 45310 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD
SUITE C
VENTURA CA 93003
VENTURA COUNTY
