Provider Demographics
NPI:1083789309
Name:SZETO, DOUGLAS S (DMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:SZETO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:S
Other - Last Name:SZETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:22982 EL TORO ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:949-305-0202
Mailing Address - Fax:949-305-0203
Practice Address - Street 1:22982 EL TORO ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-305-0202
Practice Address - Fax:949-305-0203
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics