Provider Demographics
NPI:1184845091
Name:CORTEZ, MIGUEL A (DDS)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:CORTEZ
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 1:2628 EL CAMINO AVE STE B7
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5925
Mailing Address - Country:US
Mailing Address - Phone:916-514-0489
Mailing Address - Fax:916-307-5872
Practice Address - Street 1:2628 EL CAMINO AVE STE B7
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5925
Practice Address - Country:US
Practice Address - Phone:916-514-0489
Practice Address - Fax:916-307-5872
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice