Provider Demographics
NPI:1629178058
Name:LADERA RANCH DENTISTRY
Entity Type:Organization
Organization Name:LADERA RANCH DENTISTRY
Other - Org Name:LADERA RANCH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-347-0800
Mailing Address - Street 1:25612 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE L-7
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0475
Mailing Address - Country:US
Mailing Address - Phone:949-347-0800
Mailing Address - Fax:949-606-7219
Practice Address - Street 1:25612 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE L-7
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0475
Practice Address - Country:US
Practice Address - Phone:949-347-0800
Practice Address - Fax:949-606-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992153OtherUNITED CONCORDIA
CA1992205OtherUNITED CONCORDIA