Provider Demographics
NPI:1477799609
Name:DR. SERENA G. PUGEDA, DMD
Entity Type:Organization
Organization Name:DR. SERENA G. PUGEDA, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST.
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PUGEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-446-7768
Mailing Address - Street 1:2370 MARITIME DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3639
Mailing Address - Country:US
Mailing Address - Phone:916-446-7768
Mailing Address - Fax:916-446-9014
Practice Address - Street 1:2370 MARITIME DRIVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3639
Practice Address - Country:US
Practice Address - Phone:916-446-7768
Practice Address - Fax:916-446-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty