Provider Demographics
NPI:1366814477
Name:CARRASCO, CESAR (DDS)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:CARRASCO
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 1:21008 VICTOR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2846
Mailing Address - Country:US
Mailing Address - Phone:818-392-9634
Mailing Address - Fax:
Practice Address - Street 1:21008 VICTOR ST APT 4
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2846
Practice Address - Country:US
Practice Address - Phone:818-392-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist