Provider Demographics
NPI:1093839961
Name:CENDANA, GERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:
Last Name:CENDANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 FETLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-6075
Mailing Address - Country:US
Mailing Address - Phone:916-714-3104
Mailing Address - Fax:
Practice Address - Street 1:9216 KIEFER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5418
Practice Address - Country:US
Practice Address - Phone:916-363-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice