Provider Demographics
NPI:1619271434
Name:CARDENAS, GILBERTO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:CARDENAS
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 1:4851 DATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1339
Mailing Address - Country:US
Mailing Address - Phone:619-527-8138
Mailing Address - Fax:
Practice Address - Street 1:CALLE HUETAMO 90-A
Practice Address - Street 2:FRACC. EL PEDREGAL
Practice Address - City:TECATE
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21460
Practice Address - Country:MX
Practice Address - Phone:665-654-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ36206311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice