Provider Demographics
NPI:1689854648
Name:CANCIO, JUAN POCHOLO BALINGIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN POCHOLO
Middle Name:BALINGIT
Last Name:CANCIO
Suffix:
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 1:2050 S. CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011
Mailing Address - Country:US
Mailing Address - Phone:213-765-0075
Mailing Address - Fax:213-765-0917
Practice Address - Street 1:2050 S. CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:213-765-0075
Practice Address - Fax:213-765-0917
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist