Provider Demographics
NPI:1689789711
Name:VERCELES, ROBERT TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:VERCELES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HARDER RD STE A
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-2827
Mailing Address - Country:US
Mailing Address - Phone:510-538-6816
Mailing Address - Fax:510-538-6818
Practice Address - Street 1:146 HARDER RD STE A
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2827
Practice Address - Country:US
Practice Address - Phone:510-538-6816
Practice Address - Fax:510-538-6818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice