Basic Information
Provider Information
NPI: 1003010448
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SETTI
FirstName: CARLOS
MiddleName: EDUARDO
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8747 SANTA MONICA BLVD
Address2:  
City: WEST HOLLYWOOD
State: CA
PostalCode: 900694507
CountryCode: US
TelephoneNumber: 3106590120
FaxNumber: 3232582145
Practice Location
Address1: 8747 SANTA MONICA BLVD
Address2:  
City: WEST HOLLYWOOD
State: CA
PostalCode: 900694507
CountryCode: US
TelephoneNumber: 3106590120
FaxNumber: 3232582145
Other Information
ProviderEnumerationDate: 06/11/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X44080CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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