Provider Demographics
NPI:1922173673
Name:BULUCEA, SOPHIA I (DMD)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:I
Last Name:BULUCEA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10353 TORRE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3217
Mailing Address - Country:US
Mailing Address - Phone:408-257-0723
Mailing Address - Fax:408-257-0726
Practice Address - Street 1:10353 TORRE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3217
Practice Address - Country:US
Practice Address - Phone:408-257-0723
Practice Address - Fax:408-257-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist