Provider Demographics
NPI:1033376728
Name:TRITICO, EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TRITICO
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 1:1710 MEMORIAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5700
Mailing Address - Country:US
Mailing Address - Phone:831-637-8133
Mailing Address - Fax:831-637-4099
Practice Address - Street 1:1710 MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5700
Practice Address - Country:US
Practice Address - Phone:831-637-8133
Practice Address - Fax:831-637-4099
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0324091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry