Provider Demographics
NPI:1508984790
Name:RAGADIO, ANTONIO CORPUZ JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:CORPUZ
Last Name:RAGADIO
Suffix:JR
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 1:1100 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3822
Mailing Address - Country:US
Mailing Address - Phone:415-587-1200
Mailing Address - Fax:415-587-3025
Practice Address - Street 1:1100 GENEVA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3822
Practice Address - Country:US
Practice Address - Phone:415-587-1200
Practice Address - Fax:415-587-3025
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice