Provider Demographics
NPI:1073697751
Name:PIERACCINI, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:PIERACCINI
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 1:30 CALEDONIA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2179
Mailing Address - Country:US
Mailing Address - Phone:415-332-1414
Mailing Address - Fax:415-332-1450
Practice Address - Street 1:30 CALEDONIA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2179
Practice Address - Country:US
Practice Address - Phone:415-332-1414
Practice Address - Fax:415-332-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice