Provider Demographics
NPI:1235750704
Name:CADRA, ERIK PAUL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:PAUL
Last Name:CADRA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5090
Mailing Address - Country:US
Mailing Address - Phone:661-259-7272
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 205
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:661-259-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty