Provider Demographics
NPI:1912386608
Name:GIACHETTI, ERNEST GORDON
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:GORDON
Last Name:GIACHETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20445 PACIFICA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3095
Mailing Address - Country:US
Mailing Address - Phone:408-252-8395
Mailing Address - Fax:408-252-8310
Practice Address - Street 1:20445 PACIFICA DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3095
Practice Address - Country:US
Practice Address - Phone:408-252-8395
Practice Address - Fax:408-252-8310
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice