Provider Demographics
NPI:1134984719
Name:CUPERTINO DENTAL GROUP PARTNERSHIP
Entity type:Organization
Organization Name:CUPERTINO DENTAL GROUP PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-257-3031
Mailing Address - Street 1:10383 TORRE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3297
Mailing Address - Country:US
Mailing Address - Phone:408-257-3031
Mailing Address - Fax:
Practice Address - Street 1:10383 TORRE AVE STE I
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3297
Practice Address - Country:US
Practice Address - Phone:408-257-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUPERTINO DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty