Provider Demographics
NPI:1366642530
Name:MICHAEL R. RICUPITO, DDS, MS, INC.
Entity Type:Organization
Organization Name:MICHAEL R. RICUPITO, DDS, MS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICUPITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:510-797-6500
Mailing Address - Street 1:39572 STEVENSON PL
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3075
Mailing Address - Country:US
Mailing Address - Phone:510-797-6500
Mailing Address - Fax:
Practice Address - Street 1:39572 STEVENSON PL
Practice Address - Street 2:SUITE 230
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3075
Practice Address - Country:US
Practice Address - Phone:510-797-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31849261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental