Provider Demographics
NPI:1306041611
Name:ELIGIO, ARSENIO DAVID JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARSENIO
Middle Name:DAVID
Last Name:ELIGIO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ARSENIO
Other - Middle Name:DAVID
Other - Last Name:ELIGIO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:500 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4327
Mailing Address - Country:US
Mailing Address - Phone:650-871-2700
Mailing Address - Fax:650-871-2730
Practice Address - Street 1:500 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4327
Practice Address - Country:US
Practice Address - Phone:650-871-2700
Practice Address - Fax:650-871-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice