Provider Demographics
NPI:1821141128
Name:SAUCEDO, REUBEN I (DDS)
Entity Type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:I
Last Name:SAUCEDO
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 1:14461 MERCED AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5100
Mailing Address - Country:US
Mailing Address - Phone:626-939-9116
Mailing Address - Fax:
Practice Address - Street 1:14461 MERCED AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5100
Practice Address - Country:US
Practice Address - Phone:626-939-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD43492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92096-01OtherDENTI-CAL