Provider Demographics
NPI:1760678908
Name:ETESON, DONNA JANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JANE
Last Name:ETESON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2601 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5215
Mailing Address - Country:US
Mailing Address - Phone:310-581-5757
Mailing Address - Fax:310-581-5759
Practice Address - Street 1:2601 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5215
Practice Address - Country:US
Practice Address - Phone:310-581-5757
Practice Address - Fax:310-581-5759
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA271241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics