Provider Demographics
NPI:1871680140
Name:CEDANO, CARLOS (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:CEDANO
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 EAST 156TH STREET APMT 8B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4854
Mailing Address - Country:US
Mailing Address - Phone:718-993-3434
Mailing Address - Fax:
Practice Address - Street 1:304 E 156TH ST APT 8B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4854
Practice Address - Country:US
Practice Address - Phone:718-993-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018194-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist