Provider Demographics
NPI:1649478769
Name:SAUCEDO, MARTHA VERONICA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:VERONICA
Last Name:SAUCEDO
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 1:1150 N MOUNTAIN AVE
Mailing Address - Street 2:113
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3668
Mailing Address - Country:US
Mailing Address - Phone:909-981-9595
Mailing Address - Fax:909-981-9550
Practice Address - Street 1:1150 N MOUNTAIN AVE
Practice Address - Street 2:113
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3668
Practice Address - Country:US
Practice Address - Phone:909-981-9595
Practice Address - Fax:909-981-9550
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice