Provider Demographics
NPI:1063595940
Name:PRECIADO, CAROL (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 VAN NUYS BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4810
Mailing Address - Country:US
Mailing Address - Phone:818-786-7986
Mailing Address - Fax:818-786-8609
Practice Address - Street 1:8215 VAN NUYS BLVD
Practice Address - Street 2:STE 302
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4810
Practice Address - Country:US
Practice Address - Phone:818-786-7986
Practice Address - Fax:818-786-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist