Provider Demographics
NPI:1962749861
Name:PERES ELEMENTARY SCHOOL
Entity type:Organization
Organization Name:PERES ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-236-1661
Mailing Address - Street 1:719 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-2654
Mailing Address - Country:US
Mailing Address - Phone:510-231-1407
Mailing Address - Fax:
Practice Address - Street 1:719 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-2654
Practice Address - Country:US
Practice Address - Phone:510-231-1407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93840-01OtherDENTI-CAL