Provider Demographics
NPI:1679650360
Name:PEREIRA, SERGIO
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:PEREIRA
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 1:5700 WHITELOCK PKWY
Mailing Address - Street 2:# 120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5925
Mailing Address - Country:US
Mailing Address - Phone:916-714-3344
Mailing Address - Fax:916-714-3304
Practice Address - Street 1:5700 WHITELOCK PKWY
Practice Address - Street 2:# 120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5925
Practice Address - Country:US
Practice Address - Phone:916-714-3344
Practice Address - Fax:916-714-3304
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice