Provider Demographics
NPI:1407982176
Name:SANTUCCI, EUGENE THOMAS (DDS,)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:THOMAS
Last Name:SANTUCCI
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 1:20265 LAKE CHABOT RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5307
Mailing Address - Country:US
Mailing Address - Phone:510-881-8010
Mailing Address - Fax:
Practice Address - Street 1:20265 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5307
Practice Address - Country:US
Practice Address - Phone:510-881-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist