Provider Demographics
NPI:1437319050
Name:DATU, TEODORA SABANAL (DDS)
Entity Type:Individual
Prefix:
First Name:TEODORA
Middle Name:SABANAL
Last Name:DATU
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 1:675 NAPLES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3552
Mailing Address - Country:US
Mailing Address - Phone:415-452-4235
Mailing Address - Fax:
Practice Address - Street 1:675 NAPLES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3552
Practice Address - Country:US
Practice Address - Phone:415-452-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice