Provider Demographics
NPI:1578633582
Name:PEDRAZA, LOURDES (DDS)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2609
Mailing Address - Country:US
Mailing Address - Phone:650-938-9000
Mailing Address - Fax:650-938-9200
Practice Address - Street 1:451 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2609
Practice Address - Country:US
Practice Address - Phone:650-938-9000
Practice Address - Fax:650-938-9200
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice