Provider Demographics
NPI:1235153594
Name:CARANDANG-LIBERTY, DIANE B (DDS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:CARANDANG-LIBERTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:BAZA
Other - Last Name:CARANDANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8008 FOLSOM AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1664
Mailing Address - Country:US
Mailing Address - Phone:916-988-7790
Mailing Address - Fax:916-988-5447
Practice Address - Street 1:8008 FOLSOM AUBURN RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-1664
Practice Address - Country:US
Practice Address - Phone:916-988-7790
Practice Address - Fax:916-988-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice