Provider Demographics
NPI:1508002668
Name:CANTERO, MIGUEL ANGEL (RDA EF)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CANTERO
Suffix:
Gender:M
Credentials:RDA EF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5645
Mailing Address - Country:US
Mailing Address - Phone:310-325-8888
Mailing Address - Fax:310-325-3024
Practice Address - Street 1:1730 SEPULVEDA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5645
Practice Address - Country:US
Practice Address - Phone:310-325-8888
Practice Address - Fax:310-325-3024
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44265126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant