Healthcare Provider Details

I. General information

NPI: 1689861841
Provider Name (Legal Business Name): TUOLUMNE COUNTY OFFICE OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FAIRVIEW LN
SONORA CA
95370-4809
US

IV. Provider business mailing address

175 FAIRVIEW LN
SONORA CA
95370-4809
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-2225
  • Fax: 209-536-2003
Mailing address:
  • Phone: 209-533-2225
  • Fax: 209-536-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY A. MOE
Title or Position: DENTIST
Credential: DDS
Phone: 209-533-2225