Provider Demographics
NPI:1003384579
Name:DAVID CEDENO MD DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID CEDENO MD DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONNARAGORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-270-3235
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 1510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4006
Mailing Address - Country:US
Mailing Address - Phone:213-977-0943
Mailing Address - Fax:213-977-0139
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4006
Practice Address - Country:US
Practice Address - Phone:213-977-0943
Practice Address - Fax:213-977-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty