Provider Demographics
NPI:1700207883
Name:REUBEN I. SAUCEDO DDS INC.
Entity Type:Organization
Organization Name:REUBEN I. SAUCEDO DDS INC.
Other - Org Name:ROSEDALE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-633-1080
Mailing Address - Street 1:105 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2445
Mailing Address - Country:US
Mailing Address - Phone:626-633-1080
Mailing Address - Fax:626-633-1096
Practice Address - Street 1:105 E 10TH ST
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2445
Practice Address - Country:US
Practice Address - Phone:626-633-1080
Practice Address - Fax:626-633-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty