Provider Demographics
NPI:1972610657
Name:SONIA CARTAGENA DDS INC
Entity Type:Organization
Organization Name:SONIA CARTAGENA DDS INC
Other - Org Name:SONIA CARTAGENA DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:AU
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-827-2131
Mailing Address - Street 1:4183 BALL RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-827-2131
Mailing Address - Fax:714-827-0832
Practice Address - Street 1:4183 BALL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:714-827-2131
Practice Address - Fax:714-827-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4189701OtherDENTICAL