Provider Demographics
NPI:1841019809
Name:DAVID R. DATWYLER, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DAVID R. DATWYLER, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-409-4614
Mailing Address - Street 1:3605 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5301
Mailing Address - Country:US
Mailing Address - Phone:775-409-4614
Mailing Address - Fax:
Practice Address - Street 1:3903 PARK DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4561
Practice Address - Country:US
Practice Address - Phone:916-260-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty