MEDICARE: PETER D. CANCELLIER, DDS, APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	30764	CA

General Provider Information

NPI Number	:	1679957054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER D. CANCELLIER, DDS, APC

Provider Business Mailing Address
First Line	:	33 CREEK RD., #330
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7705
Country	:	US
Telephone Number	:	949-857-3636
Fax Number	:	949-857-5766

Provider Business Practice Location Address
First Line	:	33 CREEK RD., #330
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7705
Country	:	US
Telephone Number	:	949-857-3636
Fax Number	:	949-857-5766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER D CANCELLIER
Credential	:	DDS
Telephone Number	:	949-857-3636

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	07/23/2015

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