Brandon V. Cuccia, DDS
Individual provider Active NPI Dentist · San Marino, CA
NPI 1609897362 · NPPES record last updated Jan 31, 2017
Key facts
- NPI
- 1609897362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 38175 (CA)
- Practice address
- 2384 Huntington Dr
San Marino, CA 91108-2641 - Phone
- (626) 286-6680
- Fax
- (626) 286-7619
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38175 | CA | MD | Licensed Psychiatric Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LSCJ | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 38175 | CA | Yes |
Addresses
Primary practice location
2384 Huntington Dr
San Marino, CA 91108-2641
Mailing address
45 Kewen PL
San Marino, CA 91108-1104
Phone (626) 286-6680
Other names
- LSCJ Inc
Other providers in San Marino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.