Provider Demographics
NPI:1508599887
Name:CARDENAS DUARTE DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:CARDENAS DUARTE DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUARTW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-644-9414
Mailing Address - Street 1:2505 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4302
Mailing Address - Country:US
Mailing Address - Phone:408-644-9414
Mailing Address - Fax:
Practice Address - Street 1:2505 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-4302
Practice Address - Country:US
Practice Address - Phone:408-644-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477782555OtherNPI