Provider Demographics
NPI:1518469550
Name:BADILLO CENTENO, URIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:URIEL
Middle Name:
Last Name:BADILLO CENTENO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:URIEL
Other - Middle Name:
Other - Last Name:BADILLO CENTENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1035 W ROBINHOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5621
Mailing Address - Country:US
Mailing Address - Phone:209-952-3687
Mailing Address - Fax:209-952-6267
Practice Address - Street 1:1035 W ROBINHOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5621
Practice Address - Country:US
Practice Address - Phone:209-952-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist