Basic Information
| Provider Information | |||||||||
| NPI: | 1225317910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONTRERAS | ||||||||
| FirstName: | RAUL | ||||||||
| MiddleName: | JUAN | ||||||||
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| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CONTRERAS | ||||||||
| OtherFirstName: | RAUL | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherCredential: | DMD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4947 HARBORD DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946182506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197334676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 S TRACY BLVD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953769103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098365441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 60700 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.