MEDICARE: DR. BRANDON V. CUCCIA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38175	CA

General Provider Information

NPI Number	:	1609897362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON V. CUCCIA DDS

Provider Business Mailing Address
First Line	:	45 KEWEN PL
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-1104
Country	:	US
Telephone Number	:	626-286-6680
Fax Number	:	626-286-7619

Provider Business Practice Location Address
First Line	:	2384 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2641
Country	:	US
Telephone Number	:	626-286-6680
Fax Number	:	626-286-7619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/31/2017

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