Provider Demographics
NPI:1083625776
Name:CERDA, SANDRA PATRICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:PATRICIA
Last Name:CERDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193946
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3946
Mailing Address - Country:US
Mailing Address - Phone:787-765-2679
Mailing Address - Fax:787-751-8637
Practice Address - Street 1:281 AVE JESUS T PINERO
Practice Address - Street 2:PLAZA EL AMAL, SUITE 211
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3901
Practice Address - Country:US
Practice Address - Phone:787-765-2679
Practice Address - Fax:787-751-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry