Provider Demographics
NPI:1679957054
Name:PETER D. CANCELLIER, DDS, APC
Entity type:Organization
Organization Name:PETER D. CANCELLIER, DDS, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CANCELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-857-3636
Mailing Address - Street 1:33 CREEK RD., #330
Mailing Address - Street 2:
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:949-857-5766
Practice Address - Street 1:33 CREEK RD., #330
Practice Address - Street 2:
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:949-857-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty