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Organization
GRACE CABILDO-RIVERA A PROFESSIONAL DENTAL CORPORATION
Active
Organization
GRACE CABILDO-RIVERA A PROFESSIONAL DENTAL CORPORATION
Active
Other names
new city dental practice
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE CABILDO RIVERA D.D.S (DOCTOR/OWNER)
(925) 755-4040
Entity
Organization
Contact information
Practice address
4847 LONE TREE WAY STE B, ANTIOCH, CA 94531-8612
(925) 755-4040
(925) 755-4041
Mailing address
4847 LONE TREE WAY STE B, ANTIOCH, CA 94531-8612
(925) 755-4040
(925) 755-4041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
48364
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1332285
UNITED CONCORDIA PROVIDER
CA
01
—
341996792
OLD TAX I.D NUMBER
CA
01
—
B48364-01
HEALTHY FAMILIES PROVIDER
CA
05
—
G9337801
—
CA
Enumeration date
07/14/2006
Last updated
10/02/2008
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