Provider Demographics
NPI:1922176775
Name:POCASANGRE, VICTORIA CAROLINA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CAROLINA
Last Name:POCASANGRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 SHAW AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4066
Mailing Address - Country:US
Mailing Address - Phone:559-765-4524
Mailing Address - Fax:559-765-4658
Practice Address - Street 1:1823 SHAW AVE. SUITE 104
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6813
Practice Address - Country:US
Practice Address - Phone:559-765-4524
Practice Address - Fax:559-765-4658
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist