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General NPI Number Information
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NPI Number | 1841571387
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Entity Type | Organization
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Legal Business Name | DAVID A PETO DDS, MSD A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 9342 DUXBURY RD
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City | LOS ANGELES
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State | CA
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Zip | 90034-1023
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Country | US
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Telephone | 310-980-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 9342 DUXBURY RD
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City | LOS ANGELES
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State | CA
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Zip | 90034-1023
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Country | US
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Telephone | 310-980-3822
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID PETO
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Credential | DDS, MSD
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Telephone | 310-980-3822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54564
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License Number State | CA
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