Provider Demographics
NPI:1104048875
Name:KANACKI, ZLATKO ANTE (DDS)
Entity type:Individual
Prefix:DR
First Name:ZLATKO
Middle Name:ANTE
Last Name:KANACKI
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 1:11270 SAN MATEO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3226
Mailing Address - Country:US
Mailing Address - Phone:909-796-1246
Mailing Address - Fax:909-796-1246
Practice Address - Street 1:11270 SAN MATEO DRIVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3226
Practice Address - Country:US
Practice Address - Phone:909-796-1246
Practice Address - Fax:909-796-1246
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45273-01OtherDENTI CAL