Provider Demographics
NPI:1255045282
Name:CDG-OP/PEDO
Entity type:Organization
Organization Name:CDG-OP/PEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-508-7528
Mailing Address - Street 1:10383 TORRE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3297
Mailing Address - Country:US
Mailing Address - Phone:408-257-3031
Mailing Address - Fax:408-257-5842
Practice Address - Street 1:10393 TORRE AVE STE L
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3235
Practice Address - Country:US
Practice Address - Phone:408-446-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty