Active NPI
Daniel Teboul, DDS
- Periodontics
- South Gate, CA
National Provider Identifier
1770617003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 49419
- Practice address
- 4444 Tweedy Blvd
South Gate, CA 90280-6304 - Phone
- (323) 564-2444
- Fax
- (323) 249-7565
- NPI assigned
- Mar 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 49419 | CA | Primary |
Addresses
Primary practice location
4444 Tweedy Blvd
South Gate, CA 90280-6304
Mailing address
107 N Maple Dr
Beverly Hills, CA 90210-5502
Phone (323) 564-2444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160118000955 | CA | Order and Referring Only - Dentist | 6608179171 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49419 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770617003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 N MAPLE DR",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902105502",
"telephone_number": "323-564-2444",
"fax_number": "323-249-7565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 TWEEDY BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902806304",
"telephone_number": "323-564-2444",
"fax_number": "323-249-7565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBOUL",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "49419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.