Provider Demographics
NPI:1922366574
Name:RONTAL, TANE TANZO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANE
Middle Name:TANZO
Last Name:RONTAL
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 1:2201 BALFOUR RD
Mailing Address - Street 2:STE. D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4927
Mailing Address - Country:US
Mailing Address - Phone:925-516-8886
Mailing Address - Fax:925-516-9876
Practice Address - Street 1:2201 BALFOUR RD
Practice Address - Street 2:STE. D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4927
Practice Address - Country:US
Practice Address - Phone:925-516-8886
Practice Address - Fax:925-516-9876
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist