Provider Demographics
NPI:1881863066
Name:DAVID A PETO DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID A PETO DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-556-4431
Mailing Address - Street 1:1445 REEVES ST APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2965
Mailing Address - Country:US
Mailing Address - Phone:310-556-4431
Mailing Address - Fax:
Practice Address - Street 1:1125 S BEVERLY DR STE 750B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1130
Practice Address - Country:US
Practice Address - Phone:310-277-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty