Provider Demographics
NPI:1285788976
Name:CANCELLIER, PETER D (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:CANCELLIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:DANIELE
Other - Last Name:CANCELLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:33 CREEK RD.
Mailing Address - Street 2:#330
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7705
Mailing Address - Country:US
Mailing Address - Phone:949-857-3636
Mailing Address - Fax:
Practice Address - Street 1:33 CREEK RD.
Practice Address - Street 2:#330
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7705
Practice Address - Country:US
Practice Address - Phone:949-857-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics