Provider Demographics
NPI:1922093145
Name:MONCADA, SERGIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:MONCADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:MONCADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2227 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3505
Mailing Address - Country:US
Mailing Address - Phone:714-547-2814
Mailing Address - Fax:714-953-0141
Practice Address - Street 1:2227 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3505
Practice Address - Country:US
Practice Address - Phone:714-547-2814
Practice Address - Fax:714-953-0141
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice