Provider Demographics
NPI:1982917043
Name:ALBUREZ-SOSA, CESAR RAUL (DDS)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:RAUL
Last Name:ALBUREZ-SOSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CESAR
Other - Middle Name:RAUL LUCAS
Other - Last Name:ALBUREZ SOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:615 DOISY LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1038
Mailing Address - Country:US
Mailing Address - Phone:860-538-4064
Mailing Address - Fax:
Practice Address - Street 1:819 BLOOMINGTON RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-2101
Practice Address - Country:US
Practice Address - Phone:860-538-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ28421223G0001X
IL019.0297591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice