Provider Demographics
NPI:1760636195
Name:CANCIO, CAROLYN ARISTORENAS (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ARISTORENAS
Last Name:CANCIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:SUITE #801
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-661-8001
Mailing Address - Fax:323-661-8009
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE #801
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-661-8001
Practice Address - Fax:323-661-8009
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice