Provider Demographics
NPI:1841410511
Name:DECENA, AGNES (DMD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:DECENA
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 1:371 JOAQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4711
Mailing Address - Country:US
Mailing Address - Phone:510-895-3250
Mailing Address - Fax:510-895-3252
Practice Address - Street 1:371 JOAQUIN AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4711
Practice Address - Country:US
Practice Address - Phone:510-895-3250
Practice Address - Fax:510-895-3252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice