Provider Demographics
NPI:1275536187
Name:CUPPLES, JOHN STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:CUPPLES
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 1:1660 WILLOW ST
Mailing Address - Street 2:#6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5101
Mailing Address - Country:US
Mailing Address - Phone:408-264-8515
Mailing Address - Fax:408-264-0250
Practice Address - Street 1:1660 WILLOW ST
Practice Address - Street 2:#6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5101
Practice Address - Country:US
Practice Address - Phone:408-264-8515
Practice Address - Fax:408-264-0250
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA227931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice