Provider Demographics
NPI:1841662699
Name:CARRAZANA, VICENTE (DDS)
Entity type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:
Last Name:CARRAZANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:
Other - Last Name:CARRAZANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:675 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3373
Mailing Address - Country:US
Mailing Address - Phone:312-375-0435
Mailing Address - Fax:
Practice Address - Street 1:675 PINE AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3373
Practice Address - Country:US
Practice Address - Phone:831-649-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61274122300000X
MO2015037416122300000X
CADDS107471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist