Provider Demographics
NPI:1598863995
Name:SERNA-ARAGOZA, MARISSA TALAVERA (DDS)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:TALAVERA
Last Name:SERNA-ARAGOZA
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 1:3071 STANFORD RANCH ROAD
Mailing Address - Street 2:SUITE C3
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:916-435-2864
Mailing Address - Fax:916-435-5981
Practice Address - Street 1:3071 STANFORD RANCH ROAD
Practice Address - Street 2:SUITE C3
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765
Practice Address - Country:US
Practice Address - Phone:916-435-2864
Practice Address - Fax:916-435-5981
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist