Provider Demographics
NPI:1316337785
Name:MIGUEL A. CORTEZ DENTAL CORPORATION
Entity type:Organization
Organization Name:MIGUEL A. CORTEZ DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-514-0489
Mailing Address - Street 1:2628 EL CAMINO AVE STE B7
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5925
Mailing Address - Country:US
Mailing Address - Phone:916-514-0489
Mailing Address - Fax:916-307-5872
Practice Address - Street 1:2628 EL CAMINO AVE STE B7
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5925
Practice Address - Country:US
Practice Address - Phone:916-514-0489
Practice Address - Fax:916-307-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty