=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730564501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH A CUPINO DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2015
-----------------------------------------------------
Last Update Date | 07/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12146 SOUTH ST SUITE E
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-924-1007
-----------------------------------------------------
Fax | 562-924-1267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12146 SOUTH ST SUITE E
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-924-1007
-----------------------------------------------------
Fax | 562-924-1267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | FIDEL CUPINO
-----------------------------------------------------
Credential | P.E.
-----------------------------------------------------
Telephone | 562-881-1615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | DDS 41910
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------