Provider Demographics
NPI:1336358902
Name:SISON-ROSARIO, MARIA VICTORIA C (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:C
Last Name:SISON-ROSARIO
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 1:152 W BASTANCHURY RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2502
Mailing Address - Country:US
Mailing Address - Phone:714-890-1171
Mailing Address - Fax:714-870-9330
Practice Address - Street 1:152 W BASTANCHURY RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2502
Practice Address - Country:US
Practice Address - Phone:714-890-1171
Practice Address - Fax:714-870-9330
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist