Healthcare Provider Details

I. General information

NPI: 1134984719
Provider Name (Legal Business Name): CUPERTINO DENTAL GROUP PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10383 TORRE AVE STE I
CUPERTINO CA
95014-3297
US

IV. Provider business mailing address

10383 TORRE AVE STE I
CUPERTINO CA
95014-3297
US

V. Phone/Fax

Practice location:
  • Phone: 408-257-3031
  • Fax:
Mailing address:
  • Phone: 408-257-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MELINA LUCCHINI
Title or Position: SUPERVISOR
Credential:
Phone: 408-257-3031