Provider Demographics
NPI:1912379819
Name:CERVANTES DENTAL CORPORATION
Entity Type:Organization
Organization Name:CERVANTES DENTAL CORPORATION
Other - Org Name:CALIDENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-747-4242
Mailing Address - Street 1:PO BOX 33448
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3448
Mailing Address - Country:US
Mailing Address - Phone:760-747-4242
Mailing Address - Fax:
Practice Address - Street 1:342 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4207
Practice Address - Country:US
Practice Address - Phone:760-747-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty