Provider Demographics
NPI:1396863551
Name:DU, AUDREY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:DU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 GARVEY AVE STE H
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2475
Mailing Address - Country:US
Mailing Address - Phone:626-401-1235
Mailing Address - Fax:626-401-1239
Practice Address - Street 1:11230 GARVEY AVE STE H
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2475
Practice Address - Country:US
Practice Address - Phone:626-401-1235
Practice Address - Fax:626-401-1239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice