Provider Demographics
NPI:1891269262
Name:CESAR CARRASCO DDS INC
Entity Type:Organization
Organization Name:CESAR CARRASCO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-392-9634
Mailing Address - Street 1:21847 S AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-549-9710
Mailing Address - Fax:310-549-4049
Practice Address - Street 1:21847 S AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-549-9710
Practice Address - Fax:310-549-4049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CESAR CARRASCO DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty