Provider Demographics
NPI:1871688465
Name:ARREDONDO, MANUEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:ARREDONDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:293 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5421
Mailing Address - Country:US
Mailing Address - Phone:619-422-6359
Mailing Address - Fax:619-422-3796
Practice Address - Street 1:293 E ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5421
Practice Address - Country:US
Practice Address - Phone:619-422-6359
Practice Address - Fax:619-422-3796
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639379803OtherMANUEL ARREDONDO DENTAL CORPORATION
CAB4330901Medicaid