Provider Demographics
NPI:1881916443
Name:CERVANTES AND PRADO DENTAL CARE, INC
Entity type:Organization
Organization Name:CERVANTES AND PRADO DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-557-5822
Mailing Address - Street 1:PO BOX 9067
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-9067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 VALLE VISTA AVE STE 150
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2886
Practice Address - Country:US
Practice Address - Phone:707-557-5822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty