Provider Demographics
NPI:1689864639
Name:CYRUS, ANTONIA MARGARETA (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:MARGARETA
Last Name:CYRUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 DANVILLE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1905
Mailing Address - Country:US
Mailing Address - Phone:925-837-6052
Mailing Address - Fax:925-837-3768
Practice Address - Street 1:3176 DANVILLE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1905
Practice Address - Country:US
Practice Address - Phone:925-837-6052
Practice Address - Fax:925-837-3768
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice