Provider Demographics
NPI:1780717959
Name:CRISTOBAL, AMOR ROBIANES (DMD DENTIST)
Entity type:Individual
Prefix:
First Name:AMOR
Middle Name:ROBIANES
Last Name:CRISTOBAL
Suffix:
Gender:M
Credentials:DMD DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 LAGUNA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-478-2728
Mailing Address - Fax:916-478-2729
Practice Address - Street 1:7805 LAGUNA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-478-2728
Practice Address - Fax:916-478-2729
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice