Provider Demographics
NPI:1457474371
Name:ROBERT DYER DDS & CHRISTINA FANTINO DDS DBA OAK MEADOW DENTAL CENTER
Entity Type:Organization
Organization Name:ROBERT DYER DDS & CHRISTINA FANTINO DDS DBA OAK MEADOW DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-395-1121
Mailing Address - Street 1:210 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4407
Mailing Address - Country:US
Mailing Address - Phone:408-395-1121
Mailing Address - Fax:
Practice Address - Street 1:210 OAK MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4407
Practice Address - Country:US
Practice Address - Phone:408-395-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty