Provider Demographics
NPI:1063770691
Name:CAESAR, DARRYL ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:ANTHONY
Last Name:CAESAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 E MORADA LANE
Mailing Address - Street 2:#2-303
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212
Mailing Address - Country:US
Mailing Address - Phone:443-934-2237
Mailing Address - Fax:
Practice Address - Street 1:678 N WILSON WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4272
Practice Address - Country:US
Practice Address - Phone:209-235-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1012951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics