Provider Demographics
NPI:1932779618
Name:DENTAL PRACTICE OF A.F. CONCEPCION
Entity Type:Organization
Organization Name:DENTAL PRACTICE OF A.F. CONCEPCION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-931-9510
Mailing Address - Street 1:7605 SILVER OAK PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8803
Mailing Address - Country:US
Mailing Address - Phone:909-463-0073
Mailing Address - Fax:
Practice Address - Street 1:130 S MOUNTAIN AVE STE G
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6269
Practice Address - Country:US
Practice Address - Phone:909-931-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental