=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992879100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CESAR ESCUDERO DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20445 PROSPECT RD SUITE 4
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-446-2200
-----------------------------------------------------
Fax | 408-446-1040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20445 PROSPECT RD SUITE 4
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-446-2200
-----------------------------------------------------
Fax | 408-446-1040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 41246
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------