Provider Demographics
NPI:1831349778
Name:PANTANGCO, IRINEO MARVIN III (DDS)
Entity type:Individual
Prefix:DR
First Name:IRINEO
Middle Name:MARVIN
Last Name:PANTANGCO
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:
Other - Last Name:PANTANGCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:760-536-1199
Mailing Address - Fax:888-825-5351
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:SUITE 106
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-536-1199
Practice Address - Fax:888-825-5351
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice