Provider Demographics
NPI:1497829527
Name:CERVANTES, RUPERT EMIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:EMIL
Last Name:CERVANTES
Suffix:
Gender:M
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:PO BOX 9067
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-9067
Mailing Address - Country:US
Mailing Address - Phone:818-357-8568
Mailing Address - Fax:
Practice Address - Street 1:1620 VALLE VISTA AVE STE 150
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2886
Practice Address - Country:US
Practice Address - Phone:707-557-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice