Provider Demographics
NPI:1578989927
Name:DAVID J. TANCRETO, D.D.S., P.C.
Entity Type:Organization
Organization Name:DAVID J. TANCRETO, D.D.S., P.C.
Other - Org Name:CONCORD ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANCRETO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-686-5200
Mailing Address - Street 1:2991 TREAT BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3616
Mailing Address - Country:US
Mailing Address - Phone:925-686-5200
Mailing Address - Fax:925-686-5847
Practice Address - Street 1:2991 TREAT BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3616
Practice Address - Country:US
Practice Address - Phone:925-686-5200
Practice Address - Fax:925-686-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty