Provider Demographics
NPI:1194051292
Name:LOURDES CARDOSO DDS INC.
Entity type:Organization
Organization Name:LOURDES CARDOSO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-988-1800
Mailing Address - Street 1:1051 N. MOUNTAIN AVE.
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:909-988-1800
Mailing Address - Fax:909-988-1833
Practice Address - Street 1:1051 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2157
Practice Address - Country:US
Practice Address - Phone:909-988-1800
Practice Address - Fax:909-988-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50895261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental