Provider Demographics
NPI:1457620254
Name:DECOITE, EDWARD ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:DECOITE
Suffix:
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 1:43195 MISSION BLVD.
Mailing Address - Street 2:SUITE A-Z
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539
Mailing Address - Country:US
Mailing Address - Phone:510-657-5744
Mailing Address - Fax:510-657-5611
Practice Address - Street 1:43195 MISSION BLVD.
Practice Address - Street 2:SUITE A-Z
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539
Practice Address - Country:US
Practice Address - Phone:510-657-5744
Practice Address - Fax:510-657-5611
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist