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General NPI Number Information
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NPI Number | 1609333673
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Entity Type | Organization
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Legal Business Name | JULIO E CACERES DDS, INC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 80 W GRAND BLVD STE 111
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City | CORONA
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State | CA
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Zip | 92882-2059
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Country | US
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Telephone | 951-549-1111
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Fax | 951-549-1190
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Provider Business Mailing Address
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Address Line | 80 W GRAND BLVD STE 111
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City | CORONA
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State | CA
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Zip | 92882-2059
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Country | US
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Telephone | 951-549-1111
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Fax | 951-549-1190
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Authorized Official
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Title or Position | OWNER
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Name | JULIO E CACERES
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Credential | DDS
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Telephone | 951-549-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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