Provider Demographics
NPI:1447781026
Name:LISA CANNATELLA, DDS AND PRIYANKA MOONKA, DDS, INC
Entity Type:Organization
Organization Name:LISA CANNATELLA, DDS AND PRIYANKA MOONKA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-828-5335
Mailing Address - Street 1:9301 FIRCREST LN STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3960
Mailing Address - Country:US
Mailing Address - Phone:925-828-5335
Mailing Address - Fax:925-829-6170
Practice Address - Street 1:9301 FIRCREST LN STE 7
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3960
Practice Address - Country:US
Practice Address - Phone:925-828-5335
Practice Address - Fax:925-829-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41261122300000X
CA54869122300000X
CA35603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty