Provider Demographics
NPI:1891972063
Name:ANGELITA Y. LUCIANO D.M.D., INC.
Entity Type:Organization
Organization Name:ANGELITA Y. LUCIANO D.M.D., INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:LAPENA
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:408-258-3584
Mailing Address - Street 1:1695 ALUM ROCK AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2445
Mailing Address - Country:US
Mailing Address - Phone:408-258-3584
Mailing Address - Fax:408-258-3586
Practice Address - Street 1:1695 ALUM ROCK AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2445
Practice Address - Country:US
Practice Address - Phone:408-258-3584
Practice Address - Fax:408-258-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41274261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41274-01OtherDENTICAL