Provider Demographics
NPI:1992081061
Name:TOTTLE, CYNTHIA DIANE (DDS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:TOTTLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 PALISADE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3527
Mailing Address - Country:US
Mailing Address - Phone:510-703-0581
Mailing Address - Fax:
Practice Address - Street 1:1494 WASHINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4064
Practice Address - Country:US
Practice Address - Phone:925-672-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice