Provider Demographics
NPI:1689761504
Name:TANCRETO, DAVID J (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:TANCRETO
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 TREAT BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3604
Mailing Address - Country:US
Mailing Address - Phone:925-686-5200
Mailing Address - Fax:925-686-5847
Practice Address - Street 1:2991 TREAT BLVD STE K
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3604
Practice Address - Country:US
Practice Address - Phone:925-686-5200
Practice Address - Fax:925-686-5847
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics