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General NPI Number Information
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NPI Number | 1679690721
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Entity Type | Organization
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Legal Business Name | MAURICIO CARDENAS DDS INC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26720 TOWNE CENTRE DR SUITE #B MC COSMETIC DENTISTRY
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City | FOOTHILL RANCH
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State | CA
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Zip | 92610
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Country | US
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Telephone | 949-830-2003
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Fax | 949-830-2017
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Provider Business Mailing Address
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Address Line | 26720 TOWNE CENTRE DR SUITE #B
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City | FOOTHILL RANCH
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State | CA
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Zip | 92610
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Country | US
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Telephone | 949-830-2003
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Fax | 949-830-2017
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Authorized Official
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Title or Position | OWNER PRESIDENT DDS
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Name | MR. MAURICIO ALBERTO CARDENAS
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Credential | DDS
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Telephone | 949-830-2003
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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 | 43326
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License Number State | CA
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