Provider Demographics
NPI:1477682821
Name:OFRECIO-CEBALLOS, ROSE (DDS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:OFRECIO-CEBALLOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WESTBOROUGH BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5404
Practice Address - Country:US
Practice Address - Phone:650-875-9471
Practice Address - Fax:650-875-5949
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice