Provider Demographics
NPI:1013118488
Name:DAVID M DATU DDS
Entity Type:Organization
Organization Name:DAVID M DATU DDS
Other - Org Name:SMILE GALLERY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR DATU PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DATU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-998-2241
Mailing Address - Street 1:1107 E LINCOLN AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865
Mailing Address - Country:US
Mailing Address - Phone:714-998-2241
Mailing Address - Fax:714-998-8124
Practice Address - Street 1:1107 E LINCOLN AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865
Practice Address - Country:US
Practice Address - Phone:714-998-2241
Practice Address - Fax:714-998-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty