Provider Demographics
NPI:1548334949
Name:CAMPOS CORTES, ARIADNA (DDS)
Entity type:Individual
Prefix:
First Name:ARIADNA
Middle Name:
Last Name:CAMPOS CORTES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ARIADNA
Other - Middle Name:V
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:324 33RD STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-444-6724
Mailing Address - Fax:530-668-5508
Practice Address - Street 1:58 WEST COURT
Practice Address - Street 2:WOODLAND FAMILY DENTAL
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-668-5500
Practice Address - Fax:530-668-5508
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA547049OtherMEDICAL