Provider Demographics
NPI:1205403490
Name:ACEVES, TANIA LILIANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:LILIANNA
Last Name:ACEVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20465 AVENIDA HACIENDA
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2415
Mailing Address - Country:US
Mailing Address - Phone:951-205-9073
Mailing Address - Fax:
Practice Address - Street 1:20465 AVENIDA HACIENDA
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2415
Practice Address - Country:US
Practice Address - Phone:951-205-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2022-08-13
Deactivation Date:2022-07-17
Deactivation Code:
Reactivation Date:2022-08-11
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CADDS1075961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program