Provider Demographics
NPI:1386850154
Name:BERCASIO, LAURIE VERCELES (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:VERCELES
Last Name:BERCASIO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32475 CAPITOLA CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5164
Mailing Address - Country:US
Mailing Address - Phone:510-429-1265
Mailing Address - Fax:
Practice Address - Street 1:1270 OAKMEAD PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4041
Practice Address - Country:US
Practice Address - Phone:408-773-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH15173124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist