Organization
CHERYL G. VICENCIO, DMD, A PROFESSIONAL CORPORATION
Active
Other names
Vicencio Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL G. VICENCIO DMD (OWNER/PRESIDENT)
(408) 255-2222
Entity
Organization
Contact information
Practice address
753 SARATOGA AVE, SAN JOSE, CA 95129-2330
(408) 255-2222
(408) 255-2280
Mailing address
753 SARATOGA AVE, SAN JOSE, CA 95129-2330
(408) 255-2222
(408) 255-2280
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
39908
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B39908
MEDI-CAL/DENTI-CAL
CA
Enumeration date
06/12/2014
Last updated
06/12/2014
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