Healthcare Provider Details

I. General information

NPI: 1629935358
Provider Name (Legal Business Name): CARLOS ULISES AGUILERA CANCHOLA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43456 10TH ST. WEST
LANCASTER CA
93534
US

IV. Provider business mailing address

39812 25TH STREET WEST
PALMDALE CA
93551
US

V. Phone/Fax

Practice location:
  • Phone: 216-308-2216
  • Fax:
Mailing address:
  • Phone: 619-605-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: