Provider Demographics
NPI:1841203502
Name:CERVANTES-PRADO, VERONICA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:A
Last Name:CERVANTES-PRADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:A
Other - Last Name:PRADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 9067
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-9067
Mailing Address - Country:US
Mailing Address - Phone:707-557-5822
Mailing Address - Fax:
Practice Address - Street 1:175 W COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2913
Practice Address - Country:US
Practice Address - Phone:530-661-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice