Basic Information
Provider Information
NPI: 1003293093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DENTONE
FirstName: PETER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 200 STEIN PLAZA #1-340
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 90095
CountryCode: US
TelephoneNumber: 3108255000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/29/2015
LastUpdateDate: 01/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XA161470CAY Allopathic & Osteopathic PhysiciansOphthalmology 
207WX0009XA161470CAN    

No ID Information.


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