Provider Demographics
NPI:1326043662
Name:CEDILLO, ROGER RAMIREZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:RAMIREZ
Last Name:CEDILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2507
Mailing Address - Country:US
Mailing Address - Phone:562-907-2645
Mailing Address - Fax:
Practice Address - Street 1:8036 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2507
Practice Address - Country:US
Practice Address - Phone:562-907-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42285-01Medicaid
CAB42285-01Medicare ID - Type Unspecified