Provider Demographics
NPI:1386668911
Name:FEJARANG, CECILIA T (DMD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:T
Last Name:FEJARANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SAND CREEK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7390
Mailing Address - Country:US
Mailing Address - Phone:925-634-4200
Mailing Address - Fax:
Practice Address - Street 1:141 SAND CREEK RD
Practice Address - Street 2:SUITE G
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7390
Practice Address - Country:US
Practice Address - Phone:925-634-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice