Provider Demographics
NPI:1508469511
Name:ANTHONY CONCEPCION DDS
Entity Type:Organization
Organization Name:ANTHONY CONCEPCION DDS
Other - Org Name:ANTHONY CONCEPCION DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-981-1300
Mailing Address - Street 1:600 N MOUNTAIN AVE STE C105
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4359
Mailing Address - Country:US
Mailing Address - Phone:909-981-1300
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE STE C105
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-981-1300
Practice Address - Fax:909-981-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental