Provider Demographics
NPI:1124324561
Name:SERGIO P. SAUCEDO DDS INC.
Entity type:Organization
Organization Name:SERGIO P. SAUCEDO DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-214-6585
Mailing Address - Street 1:6165 VALLEY SPRINGS PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0963
Mailing Address - Country:US
Mailing Address - Phone:951-214-6585
Mailing Address - Fax:951-214-6589
Practice Address - Street 1:6165 VALLEY SPRINGS PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0963
Practice Address - Country:US
Practice Address - Phone:951-214-6585
Practice Address - Fax:951-214-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56687261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental