Provider Demographics
NPI:1316087919
Name:CESARE, MARIA OFELIA (DDS)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:OFELIA
Last Name:CESARE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N. BRAND BLVD.
Mailing Address - Street 2:SUITE #202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:818-244-7215
Mailing Address - Fax:818-240-3475
Practice Address - Street 1:1122 N. BRAND BLVD.
Practice Address - Street 2:SUITE #202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-244-7215
Practice Address - Fax:818-240-3475
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice