Provider Demographics
NPI:1720106511
Name:LUCIANO, ANGELITA YUMUL (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELITA
Middle Name:YUMUL
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ANGELITA
Other - Middle Name:LANSANGAN
Other - Last Name:YUMUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1695 ALUM ROCK AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-258-3584
Mailing Address - Fax:408-258-3586
Practice Address - Street 1:1695 ALUM ROCK AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-258-3584
Practice Address - Fax:408-258-3586
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4127401OtherDENTICAL