Provider Demographics
NPI:1245062660
Name:CESCA, DANIEL KEITH
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEITH
Last Name:CESCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 3RD ST UNIT 426
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1906
Mailing Address - Country:US
Mailing Address - Phone:925-989-5432
Mailing Address - Fax:
Practice Address - Street 1:615 E 3RD ST UNIT 426
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1906
Practice Address - Country:US
Practice Address - Phone:925-989-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDA78940OtherDENTAL BOARD OF CALIFORNIA