Provider Demographics
NPI:1306609334
Name:GARCIA CALDERON, FIDEL (DDS)
Entity type:Individual
Prefix:
First Name:FIDEL
Middle Name:
Last Name:GARCIA CALDERON
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 1:195 NORTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-3761
Mailing Address - Country:US
Mailing Address - Phone:951-564-7083
Mailing Address - Fax:
Practice Address - Street 1:195 NORTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3761
Practice Address - Country:US
Practice Address - Phone:951-564-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1098471223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist