Organization
DAVID R. TELLES, D.D.S., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID RODNEY TELLES D.D.S. (PRESIDENT / OMFS)
(714) 766-6560
Entity
Organization
Contact information
Practice address
7677 CENTER AVE STE 206, HUNTINGTON BEACH, CA 92647-9102
(714) 766-6560
(714) 766-6563
Mailing address
7677 CENTER AVE STE 206, HUNTINGTON BEACH, CA 92647-9102
(714) 766-6560
(714) 766-6563
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
55094
CA
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
II
TAX ID
CA
Enumeration date
10/29/2013
Last updated
06/17/2021
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