Provider Demographics
NPI:1003991266
Name:DRACHENBERG, FEDERICO G (DDS)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:G
Last Name:DRACHENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1219 ATWATER ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1453
Mailing Address - Country:US
Mailing Address - Phone:619-934-3258
Mailing Address - Fax:619-651-7578
Practice Address - Street 1:890 EASTLAKE PARKWAY
Practice Address - Street 2:STE 101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914
Practice Address - Country:US
Practice Address - Phone:619-934-3258
Practice Address - Fax:619-651-7578
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439411223G0001X
CA434911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics