Provider Demographics
NPI:1003892688
Name:LAPETODA, WAYNE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:B
Last Name:LAPETODA
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 1:4786 SEDA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2459
Mailing Address - Country:US
Mailing Address - Phone:619-890-0923
Mailing Address - Fax:
Practice Address - Street 1:4786 SEDA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2459
Practice Address - Country:US
Practice Address - Phone:619-890-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023315L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist