Provider Demographics
NPI:1396963047
Name:BERCASIO, ROLANDO M JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:M
Last Name:BERCASIO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32475 CAPITOLA CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5164
Mailing Address - Country:US
Mailing Address - Phone:510-429-1265
Mailing Address - Fax:
Practice Address - Street 1:1270 OAKMEAD PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4041
Practice Address - Country:US
Practice Address - Phone:408-773-8681
Practice Address - Fax:408-773-1198
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist