Provider Demographics
NPI:1689844938
Name:PUCCINELLI, LAWRENCE A JR (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:PUCCINELLI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:A
Other - Last Name:PUCCINELLI
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10363 TORRE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3236
Mailing Address - Country:US
Mailing Address - Phone:408-252-1970
Mailing Address - Fax:408-252-1904
Practice Address - Street 1:10363 TORRE AVE STE E
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3236
Practice Address - Country:US
Practice Address - Phone:408-252-1970
Practice Address - Fax:408-252-1904
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422141223E0200X
CA202531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics