Provider Demographics
NPI:1659464055
Name:SOBERANO, ERNESTO ALENIADO
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ALENIADO
Last Name:SOBERANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5656
Mailing Address - Country:US
Mailing Address - Phone:757-444-8654
Mailing Address - Fax:
Practice Address - Street 1:301 PRESTON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5656
Practice Address - Country:US
Practice Address - Phone:757-444-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7404124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist