Provider Demographics
NPI:1730253253
Name:ACOSTA, CESAR (DMD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 COLORADO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-2761
Mailing Address - Country:US
Mailing Address - Phone:209-250-2560
Mailing Address - Fax:209-250-2460
Practice Address - Street 1:1065 COLORADO AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-2761
Practice Address - Country:US
Practice Address - Phone:209-250-2560
Practice Address - Fax:209-250-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5050122300000X
CA569241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist