Provider Demographics
NPI:1679623623
Name:TELLES, DAVID RODNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RODNEY
Last Name:TELLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:R
Other - Last Name:TELLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7677 CENTER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9102
Mailing Address - Country:US
Mailing Address - Phone:714-766-6560
Mailing Address - Fax:714-766-6563
Practice Address - Street 1:7677 CENTER AVE STE 206
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9102
Practice Address - Country:US
Practice Address - Phone:714-766-6560
Practice Address - Fax:714-766-6563
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053873122300000X
CA550941223G0001X, 1223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice