Provider Demographics
NPI:1821137969
Name:SETIA, THEO W (DDS)
Entity Type:Individual
Prefix:MR
First Name:THEO
Middle Name:W
Last Name:SETIA
Suffix:
Gender:M
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:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-6144
Mailing Address - Country:US
Mailing Address - Phone:626-303-5995
Mailing Address - Fax:626-303-4395
Practice Address - Street 1:322 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3304
Practice Address - Country:US
Practice Address - Phone:626-303-5995
Practice Address - Fax:626-303-4395
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist