Provider Demographics
NPI:1639174279
Name:A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:A PROFESSIONAL DENTAL CORP.
Other - Org Name:A NANCY DRUMOV - DUBUK, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-756-7884
Mailing Address - Street 1:3505 LONE TREE WAY
Mailing Address - Street 2:STE 7
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6067
Mailing Address - Country:US
Mailing Address - Phone:925-756-7884
Mailing Address - Fax:925-756-7894
Practice Address - Street 1:3505 LONE TREE WAY
Practice Address - Street 2:STE 7
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6067
Practice Address - Country:US
Practice Address - Phone:925-756-7884
Practice Address - Fax:925-756-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty