Provider Demographics
NPI:1205482536
Name:LOURDES CARDOSO DDS INC.
Entity type:Organization
Organization Name:LOURDES CARDOSO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-803-8641
Mailing Address - Street 1:7270 VICTORIA PARK LN STE 3A
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1850
Mailing Address - Country:US
Mailing Address - Phone:909-803-8641
Mailing Address - Fax:909-803-8643
Practice Address - Street 1:7270 VICTORIA PARK LN STE 3A
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-1850
Practice Address - Country:US
Practice Address - Phone:909-803-8641
Practice Address - Fax:909-803-8643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOURDES CARDOSO DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental