Provider Demographics
NPI:1780744474
Name:JULIO E CACERES DDS, INC
Entity type:Organization
Organization Name:JULIO E CACERES DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-564-0510
Mailing Address - Street 1:517 N MAIN STREET
Mailing Address - Street 2:SUITE300
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-564-7610
Mailing Address - Fax:714-564-1637
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:SUITE300
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4619
Practice Address - Country:US
Practice Address - Phone:714-564-7610
Practice Address - Fax:714-564-1637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIO E CACERES DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94066-01Medicaid
CAG94066-01Medicaid