Provider Demographics
NPI:1003178062
Name:DAVID P CARTAGO DDS DENTAL PRACTICE INC
Entity type:Organization
Organization Name:DAVID P CARTAGO DDS DENTAL PRACTICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PALOMARES
Authorized Official - Last Name:CARTAGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-833-8702
Mailing Address - Street 1:425 EL PINTADO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1868
Mailing Address - Country:US
Mailing Address - Phone:925-331-7665
Mailing Address - Fax:925-833-8930
Practice Address - Street 1:2219 BUCHANAN RD
Practice Address - Street 2:STE 1
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4200
Practice Address - Country:US
Practice Address - Phone:925-331-7665
Practice Address - Fax:925-833-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty