Basic Information
| Provider Information | |||||||||
| NPI: | 1003009440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VONTELA | ||||||||
| FirstName: | REKHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 LONE TREE WAY | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257545432 | ||||||||
| FaxNumber: | 9257540877 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 LONE TREE WAY | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257545432 | ||||||||
| FaxNumber: | 9257540877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 49703 | CA | Y | Dental Providers | Dentist |
No ID Information.