Provider Demographics
NPI:1235154261
Name:ACKERMAN & TOWSON
Entity Type:Organization
Organization Name:ACKERMAN & TOWSON
Other - Org Name:LONE TREE FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:925-754-0899
Mailing Address - Street 1:3701 LONE TREE WAY
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6038
Mailing Address - Country:US
Mailing Address - Phone:925-754-0899
Mailing Address - Fax:925-754-1937
Practice Address - Street 1:3701 LONE TREE WAY
Practice Address - Street 2:SUITE 3-A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6038
Practice Address - Country:US
Practice Address - Phone:925-754-0899
Practice Address - Fax:925-754-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397421223G0001X
CA434031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty