Provider Demographics
NPI:1114068210
Name:PIINI, BRAD WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WILLIAM
Last Name:PIINI
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 1:7774 GEORGIAN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-5557
Mailing Address - Country:US
Mailing Address - Phone:925-833-9486
Mailing Address - Fax:
Practice Address - Street 1:39572 STEVENSON PL
Practice Address - Street 2:#128
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3075
Practice Address - Country:US
Practice Address - Phone:510-793-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist