Provider Demographics
NPI:1447688551
Name:DAVID R. TELLES, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DAVID R. TELLES, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OMFS
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:TELLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-766-6560
Mailing Address - Street 1:7677 CENTER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9102
Mailing Address - Country:US
Mailing Address - Phone:714-766-6560
Mailing Address - Fax:714-766-6563
Practice Address - Street 1:7677 CENTER AVE STE 206
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9102
Practice Address - Country:US
Practice Address - Phone:714-766-6560
Practice Address - Fax:714-766-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550941223S0112X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIIOtherTAX ID