Provider Demographics
NPI:1922196559
Name:EXCONDE, MA ROSARIO GUTIERREZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MA ROSARIO
Middle Name:GUTIERREZ
Last Name:EXCONDE
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 1:490 ARGUELLO DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3987
Mailing Address - Country:US
Mailing Address - Phone:707-747-1913
Mailing Address - Fax:
Practice Address - Street 1:133 PLAZA DR
Practice Address - Street 2:SUITE R
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3703
Practice Address - Country:US
Practice Address - Phone:707-557-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50414122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist