Provider Demographics
NPI:1760496640
Name:BUTSUMYO, DAVID MASA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MASA
Last Name:BUTSUMYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 480
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-4887
Mailing Address - Fax:310-540-6511
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 480
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-4887
Practice Address - Fax:310-540-6511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA325391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics