Provider Demographics
NPI:1770569600
Name:DIPONZIANO, JOHN P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:DIPONZIANO
Suffix:
Gender:M
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:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-0346
Mailing Address - Country:US
Mailing Address - Phone:510-569-0218
Mailing Address - Fax:510-569-9714
Practice Address - Street 1:680 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2904
Practice Address - Country:US
Practice Address - Phone:510-569-0218
Practice Address - Fax:510-569-9714
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist