=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346615572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN J. CESARIO DDS., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2015
-----------------------------------------------------
Last Update Date | 12/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 CAJON ST SUITE 8
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-5257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-7228
-----------------------------------------------------
Fax | 909-798-2838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 CAJON ST SUITE 8
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-5257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-7228
-----------------------------------------------------
Fax | 909-798-2838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN J CESARIO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 909-798-7228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 36065
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------