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General NPI Number Information
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NPI Number | 1215128624
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Entity Type | Organization
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Legal Business Name | VIRGILIO C CORTEZ DMD INC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 885 SCOTT BLVD SUITE 2
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City | STA CLARA
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State | CA
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Zip | 95050
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Country | US
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Telephone | 408-260-8500
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Fax | 408-260-8300
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Provider Business Mailing Address
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Address Line | 885 SCOTT BLVD SUITE 2
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City | STA CLARA
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State | CA
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Zip | 95050
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Country | US
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Telephone | 408-260-8500
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Fax | 408-260-8300
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MR. VIRGILIO CARICUNGAN CORTEZ
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Credential | DMD
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Telephone | 408-260-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45846
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License Number State | CA
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