Provider Demographics
NPI:1639219306
Name:PESTANA, FRANCISCO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:J
Last Name:PESTANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 BROADWAY ST
Mailing Address - Street 2:SUITE C1-C2
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1230
Mailing Address - Country:US
Mailing Address - Phone:707-980-7274
Mailing Address - Fax:707-731-1885
Practice Address - Street 1:3429 BROADWAY ST
Practice Address - Street 2:SUITE C1-C2
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1230
Practice Address - Country:US
Practice Address - Phone:707-980-7274
Practice Address - Fax:707-731-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47153204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47153OtherDENTI-CAL
CADS047153Medicare ID - Type UnspecifiedMEDICARE ID
CAD47153OtherDENTI-CAL