Provider Demographics
NPI:1013183383
Name:RETODO, JOHN RICHARD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD A
Last Name:RETODO
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 1:1640 W CARSON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3877
Mailing Address - Country:US
Mailing Address - Phone:310-787-9172
Mailing Address - Fax:310-320-4977
Practice Address - Street 1:1640 W CARSON ST
Practice Address - Street 2:SUITE E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3877
Practice Address - Country:US
Practice Address - Phone:310-787-9172
Practice Address - Fax:310-320-4977
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist