Provider Demographics
NPI:1568606010
Name:RICUPITO, MICHAEL R (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:RICUPITO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3880 BLACKHAWK RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4676
Mailing Address - Country:US
Mailing Address - Phone:925-736-9900
Mailing Address - Fax:510-797-6531
Practice Address - Street 1:3880 BLACKHAWK RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4676
Practice Address - Country:US
Practice Address - Phone:925-736-9900
Practice Address - Fax:510-797-6531
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics