Provider Demographics
NPI:1871502377
Name:ENVERGA, FRANCISCO C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:C
Last Name:ENVERGA
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 1:2508 S GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6253
Mailing Address - Country:US
Mailing Address - Phone:909-923-7881
Mailing Address - Fax:909-923-7852
Practice Address - Street 1:2508 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6253
Practice Address - Country:US
Practice Address - Phone:909-923-7881
Practice Address - Fax:909-923-7852
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37413OtherDENTAL LICENSE NO.
CA508330OtherUNITED CONCORDIA I. D.
CAB37413-01Medicaid