Provider Demographics
NPI:1114450475
Name:FRANCISCO J PESTANA, DMD
Entity Type:Organization
Organization Name:FRANCISCO J PESTANA, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PESTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-300-1407
Mailing Address - Street 1:3429 BROADWAY ST
Mailing Address - Street 2:SUITE C1-C2
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1230
Mailing Address - Country:US
Mailing Address - Phone:707-980-7274
Mailing Address - Fax:707-731-1885
Practice Address - Street 1:3429 BROADWAY ST
Practice Address - Street 2:SUITE C1-C2
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1230
Practice Address - Country:US
Practice Address - Phone:707-980-7274
Practice Address - Fax:707-731-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47153261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery