Provider Demographics
NPI:1205005436
Name:M.S. TANCIO, D.M.D. A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:M.S. TANCIO, D.M.D. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CIVIC CENTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-793-5033
Mailing Address - Street 1:39370 CIVIC CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6716
Mailing Address - Country:US
Mailing Address - Phone:510-793-5033
Mailing Address - Fax:510-793-5133
Practice Address - Street 1:39370 CIVIC CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6716
Practice Address - Country:US
Practice Address - Phone:510-793-5033
Practice Address - Fax:510-793-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40889261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental