Provider Demographics
NPI:1386204899
Name:CARDENAS, ANGEL ADRIAN (DMD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ADRIAN
Last Name:CARDENAS
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 1:385 BUCHHEIT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9595
Mailing Address - Country:US
Mailing Address - Phone:971-983-7353
Mailing Address - Fax:
Practice Address - Street 1:2045 MADRONA AVE SE # 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1149
Practice Address - Country:US
Practice Address - Phone:503-809-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010400122300000X
ORD11882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist