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General NPI Number Information
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NPI Number | 1881916443
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Entity Type | Organization
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Legal Business Name | CERVANTES AND PRADO DENTAL CARE, INC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1620 VALLE VISTA AVE STE 150
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City | VALLEJO
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State | CA
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Zip | 94589-2886
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Country | US
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Telephone | 707-557-5822
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9067
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City | VALLEJO
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State | CA
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Zip | 94591-9067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO, CHIEF FINANCIAL OFFICER
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Name | DR. VERONICA A PRADO
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Credential | DDS
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Telephone | 707-557-5822
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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 | 54300
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License Number State | CA
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