Provider Demographics
NPI:1689068108
Name:DANIEL TEBOUL, DDS, INC.
Entity Type:Organization
Organization Name:DANIEL TEBOUL, DDS, INC.
Other - Org Name:LOMITA TORRANCE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-539-7835
Mailing Address - Street 1:23520 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5203
Mailing Address - Country:US
Mailing Address - Phone:310-539-7835
Mailing Address - Fax:310-530-1510
Practice Address - Street 1:23520 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5203
Practice Address - Country:US
Practice Address - Phone:310-539-7835
Practice Address - Fax:310-530-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty