Provider Demographics
NPI:1285363812
Name:CARDONA, CARLOS (DDS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CARDONA
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 1:3290 ARENA BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3003
Mailing Address - Country:US
Mailing Address - Phone:916-574-9400
Mailing Address - Fax:
Practice Address - Street 1:3290 ARENA BLVD STE 610
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3003
Practice Address - Country:US
Practice Address - Phone:916-574-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1091761223G0001X
OHRES.0045081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice