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General NPI Number Information
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NPI Number | 1679957054
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Entity Type | Organization
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Legal Business Name | PETER D. CANCELLIER, DDS, APC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 33 CREEK RD., #330
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City | IRVINE
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State | CA
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Zip | 92604-7705
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Country | US
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Telephone | 949-857-3636
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Fax | 949-857-5766
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Provider Business Mailing Address
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Address Line | 33 CREEK RD., #330
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City | IRVINE
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State | CA
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Zip | 92604-7705
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Country | US
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Telephone | 949-857-3636
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Fax | 949-857-5766
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER D CANCELLIER
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Credential | DDS
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Telephone | 949-857-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 30764
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License Number State | CA
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