Basic Information
| Provider Information | |||||||||
| NPI: | 1427388875 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REKHA VONTELA DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 LONE TREE WAY STE F | ||||||||
| Address2: | ANTIOCH CA 94509 | ||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257545432 | ||||||||
| FaxNumber: | 9257540877 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 LONE TREE WAY | ||||||||
| Address2: | #F | ||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257545432 | ||||||||
| FaxNumber: | 9257540877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2010 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | VONTELA | ||||||||
| AuthorizedOfficialFirstName: | REKHA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 9257545432 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 49703 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.