Healthcare Provider Details

I. General information

NPI: 1144315524
Provider Name (Legal Business Name): CUEVAS & RAMOS PROF. DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 K STREET SUITE 205
SACRAMENTO CA
95816
US

IV. Provider business mailing address

2525 K STREET SUITE 205
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-5992
  • Fax: 916-441-5982
Mailing address:
  • Phone: 916-441-5992
  • Fax: 916-441-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43238
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL OCAMPO RAMOS
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 916-441-5992