Provider Demographics
NPI:1861477796
Name:TANIMURA, DDS, MSD AND PENG, DDS, INC.
Entity Type:Organization
Organization Name:TANIMURA, DDS, MSD AND PENG, DDS, INC.
Other - Org Name:ANTIOCH & BRENTWOOD PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TANIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:925-757-4220
Mailing Address - Street 1:2390 COUNTRY HILLS DRIVE,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-757-4220
Mailing Address - Fax:925-757-5457
Practice Address - Street 1:2901 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4963
Practice Address - Country:US
Practice Address - Phone:925-757-4220
Practice Address - Fax:925-757-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty