Provider Demographics
NPI:1316012487
Name:CERVANTES, HIRAM
Entity Type:Individual
Prefix:
First Name:HIRAM
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W ORANGE GROVE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1140
Mailing Address - Country:US
Mailing Address - Phone:520-797-4551
Mailing Address - Fax:
Practice Address - Street 1:2001 W ORANGE GROVE RD STE 206
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1140
Practice Address - Country:US
Practice Address - Phone:520-797-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4239OtherDENTAL LICENSE