Provider Demographics
NPI:1578747820
Name:SAUCEDO, SERGIO P (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:P
Last Name:SAUCEDO
Suffix:
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 1:6165 VALLEY SPRINGS PKWY.
Mailing Address - Street 2:STE. E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:951-214-6585
Mailing Address - Fax:951-214-6589
Practice Address - Street 1:6165 VALLEY SPRINGS PKWY.
Practice Address - Street 2:STE. E
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-214-6585
Practice Address - Fax:951-214-6589
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist