Provider Demographics
NPI:1891902508
Name:CACERES, FERNANDO A (DDS)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:CACERES
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 1:314 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4611
Mailing Address - Country:US
Mailing Address - Phone:760-746-7907
Mailing Address - Fax:760-746-7907
Practice Address - Street 1:314 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4611
Practice Address - Country:US
Practice Address - Phone:760-746-7907
Practice Address - Fax:760-746-7907
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist