Basic Information
| Provider Information | |||||||||
| NPI: | 1346422698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILAGON | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | LUCAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 N HERITAGE DR STE E2 | ||||||||
| Address2: | |||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935555544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604467978 | ||||||||
| FaxNumber: | 7604465998 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 N. HERITAGE DRIVE BLDGE E 2 | ||||||||
| Address2: | |||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935555537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604467978 | ||||||||
| FaxNumber: | 6614591974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
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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 | 56597 | CA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 56597 | 01 | CA | CALIFORNIA DENTAL LICENSE | OTHER |