MEDICARE: DR. ZAIDA M CESAREO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	568	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	568	OTHER	PR	DENTAL LICENSE

General Provider Information

NPI Number	:	1255313151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAIDA M CESAREO DMD

Provider Business Mailing Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	SUITE 406
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1510
Country	:	US
Telephone Number	:	787-722-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	SUITE 406
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1510
Country	:	US
Telephone Number	:	787-722-5756
Fax Number	:	787-722-5756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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