Healthcare Provider Details

I. General information

NPI: 1093325722
Provider Name (Legal Business Name): SERGIO FLORENCIO JR, DDS, DMSC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

IV. Provider business mailing address

1802 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-5526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGIO FLORENCIO JR.
Title or Position: PRESIDENT
Credential: DDS, DMSC
Phone: 925-934-5526