Provider Demographics
NPI:1811318033
Name:REUBEN I. SAUCEDO DENTAL CORPORATION
Entity type:Organization
Organization Name:REUBEN I. SAUCEDO DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-939-9116
Mailing Address - Street 1:14461 MERCED AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5100
Mailing Address - Country:US
Mailing Address - Phone:626-939-9116
Mailing Address - Fax:626-939-9119
Practice Address - Street 1:14461 MERCED AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5100
Practice Address - Country:US
Practice Address - Phone:626-939-9116
Practice Address - Fax:626-939-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty