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General NPI Number Information
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NPI Number | 1891972063
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Entity Type | Organization
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Legal Business Name | ANGELITA Y. LUCIANO D.M.D., INC.
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 1695 ALUM ROCK AVE SUITE #1
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City | SAN JOSE
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State | CA
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Zip | 95116-2445
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Country | US
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Telephone | 408-258-3584
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Fax | 408-258-3586
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Provider Business Mailing Address
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Address Line | 1695 ALUM ROCK AVE SUITE #1
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City | SAN JOSE
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State | CA
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Zip | 95116-2445
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Country | US
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Telephone | 408-258-3584
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Fax | 408-258-3586
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. BERNARDO LAPENA LUCIANO JR.
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Credential |
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Telephone | 408-258-3584
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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 | 41274
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License Number State | CA
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