Provider Demographics
NPI:1659637627
Name:CUCCIA, VICTOR RIDER (DDS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:RIDER
Last Name:CUCCIA
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 1:42215 WASHINGTON STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-772-3553
Mailing Address - Fax:760-772-3551
Practice Address - Street 1:42215 WASHINGTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8032
Practice Address - Country:US
Practice Address - Phone:760-772-3553
Practice Address - Fax:760-772-3551
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice