Healthcare Provider Details

I. General information

NPI: 1124324561
Provider Name (Legal Business Name): SERGIO P. SAUCEDO DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6165 VALLEY SPRINGS PKWY SUITE E
RIVERSIDE CA
92507-0963
US

IV. Provider business mailing address

6165 VALLEY SPRINGS PKWY SUITE E
RIVERSIDE CA
92507-0963
US

V. Phone/Fax

Practice location:
  • Phone: 951-214-6585
  • Fax: 951-214-6589
Mailing address:
  • Phone: 951-214-6585
  • Fax: 951-214-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56687
License Number StateCA

VIII. Authorized Official

Name: MR. SERGIO P SAUCEDO
Title or Position: DDS
Credential:
Phone: 951-214-6585