Provider Demographics
NPI:1225317910
Name:CONTRERAS, RAUL JUAN (DMD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:JUAN
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:J
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4947 HARBORD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2506
Mailing Address - Country:US
Mailing Address - Phone:619-733-4676
Mailing Address - Fax:
Practice Address - Street 1:2600 S TRACY BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9103
Practice Address - Country:US
Practice Address - Phone:209-836-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice