Provider Demographics
NPI:1376768010
Name:BRICCA, TIMOTHY GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:BRICCA
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 1:1201 LARKSPUR LANDING CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1807
Mailing Address - Country:US
Mailing Address - Phone:415-461-6060
Mailing Address - Fax:
Practice Address - Street 1:1201 LARKSPUR LANDING CIRCLE
Practice Address - Street 2:STE A
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1807
Practice Address - Country:US
Practice Address - Phone:415-461-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice