Provider Demographics
NPI:1972900736
Name:CAROLYN CANCIO DDS INC
Entity Type:Organization
Organization Name:CAROLYN CANCIO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-661-8001
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:SUITE 801
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-661-8001
Mailing Address - Fax:323-661-8009
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-661-8001
Practice Address - Fax:323-661-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42282261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental