Provider Demographics
NPI:1225223142
Name:RONTAL & WEDEKING DDS INC
Entity Type:Organization
Organization Name:RONTAL & WEDEKING DDS INC
Other - Org Name:DELTA BAY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDEKING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-516-8886
Mailing Address - Street 1:2201 BALFOUR RD
Mailing Address - Street 2:D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4927
Mailing Address - Country:US
Mailing Address - Phone:925-516-8886
Mailing Address - Fax:925-516-9876
Practice Address - Street 1:2201 BALFOUR RD
Practice Address - Street 2:D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4927
Practice Address - Country:US
Practice Address - Phone:925-516-8886
Practice Address - Fax:925-516-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50191122300000X
CA53859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty