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General NPI Number Information
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NPI Number | 1366642530
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Entity Type | Organization
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Legal Business Name | MICHAEL R. RICUPITO, DDS, MS, INC.
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 39572 STEVENSON PL SUITE 230
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City | FREMONT
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State | CA
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Zip | 94539-3075
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Country | US
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Telephone | 510-797-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 39572 STEVENSON PL SUITE 230
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City | FREMONT
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State | CA
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Zip | 94539-3075
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Country | US
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Telephone | 510-797-6500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL R RICUPITO
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Credential | DDS, MS
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Telephone | 510-797-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 31849
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License Number State | CA
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