Provider Demographics
NPI:1235808775
Name:CRISTOBAL, LUCAS (DDS)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:CRISTOBAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 CALLE DE LA ROSA APT 307
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-7507
Mailing Address - Country:US
Mailing Address - Phone:562-306-8230
Mailing Address - Fax:
Practice Address - Street 1:861 HAROLD PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4553
Practice Address - Country:US
Practice Address - Phone:619-216-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106536122300000X
CADDS106536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty