Provider Demographics
NPI:1760699433
Name:CASARENO, SANDRA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:R
Last Name:CASARENO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 REMORA DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2539
Mailing Address - Country:US
Mailing Address - Phone:510-429-8908
Mailing Address - Fax:
Practice Address - Street 1:5853 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1251
Practice Address - Country:US
Practice Address - Phone:510-744-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice