Provider Demographics
NPI:1194919878
Name:DR. SERENA PUGEDA, D.M.D.
Entity type:Organization
Organization Name:DR. SERENA PUGEDA, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:GUERRERO
Authorized Official - Last Name:PUGEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-446-7768
Mailing Address - Street 1:2518 L ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5655
Mailing Address - Country:US
Mailing Address - Phone:916-446-7768
Mailing Address - Fax:916-446-9014
Practice Address - Street 1:2518 L ST
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5655
Practice Address - Country:US
Practice Address - Phone:916-446-7768
Practice Address - Fax:916-446-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43064OtherDENTICAL