Healthcare Provider Details

I. General information

NPI: 1780121624
Provider Name (Legal Business Name): C. N. ZERTUCHE, INC., A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 TULLY RD STE D3
MODESTO CA
95350-0852
US

IV. Provider business mailing address

3430 TULLY RD STE 20 #516
MODESTO CA
95350-0840
US

V. Phone/Fax

Practice location:
  • Phone: 209-232-5846
  • Fax:
Mailing address:
  • Phone: 209-232-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60794
License Number StateCA

VIII. Authorized Official

Name: CHRISTINA NICOLE LEE ZERTUCHE
Title or Position: PRESIDENT
Credential:
Phone: 209-232-5846