1467105031 NPI number — CUPERTINO DENTAL SPECIALTY GROUP

Table of content: (NPI 1467105031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467105031 NPI number — CUPERTINO DENTAL SPECIALTY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUPERTINO DENTAL SPECIALTY GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467105031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10383 TORRE AVE STE I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95014-3238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-257-3031
Provider Business Mailing Address Fax Number:
408-508-7530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10373 TORRE AVENUE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-508-7560
Provider Business Practice Location Address Fax Number:
408-508-7530
Provider Enumeration Date:
02/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
LUCCHINI
Authorized Official First Name:
MELINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
408-257-3031

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com