Dental Board of California
Licensing details for: 20253
Name: PUCCINELLI, LAWRENCE A
License Type: Dentist
Primary Status: Cancelled
Secondary Status: Radiation Safety Certification issued by the Board
Address of Record
261 VALLEJO CT
MILLBRAE CA 94030
SAN MATEO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CUPERTINO ENDODONTIC DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 3276 Primary Status: Cancelled
Address :
10363 TORRE AVE STE E
CUPERTINO CA 95014
SANTA CLARA COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: CUPERTINO ENDODONTIC DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 3276 Primary Status: Cancelled
Address :
10363 TORRE AVE STE E
CUPERTINO CA 95014
SANTA CLARA COUNTY
