Provider Demographics
NPI:1679581839
Name:PEDRAZZI, MILTON E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:E
Last Name:PEDRAZZI
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 1:6501 CROWN BLVD
Mailing Address - Street 2:#102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2903
Mailing Address - Country:US
Mailing Address - Phone:408-268-5531
Mailing Address - Fax:408-268-3464
Practice Address - Street 1:6501 CROWN BLVD
Practice Address - Street 2:#102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2903
Practice Address - Country:US
Practice Address - Phone:408-268-5531
Practice Address - Fax:408-268-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice