Provider Demographics
NPI:1649817875
Name:CEDILLO FELIX, JOSE EDUARDO (DDS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EDUARDO
Last Name:CEDILLO FELIX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5993 E PACIFIC COAST HWY APT 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4964
Mailing Address - Country:US
Mailing Address - Phone:562-481-8610
Mailing Address - Fax:
Practice Address - Street 1:23609 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6023
Practice Address - Country:US
Practice Address - Phone:310-231-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist