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General NPI Number Information
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NPI Number | 1023257458
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Entity Type | Organization
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Legal Business Name | PROSTHESIS DENTAL LABORATORY, INC.
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 1350 S PARK VICTORIA DR STE 41
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City | MILPITAS
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State | CA
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Zip | 95035-6941
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Country | US
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Telephone | 408-946-3296
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Fax | 408-946-3295
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Provider Business Mailing Address
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Address Line | 1350 S PARK VICTORIA DR STE 41
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City | MILPITAS
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State | CA
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Zip | 95035-6941
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Country | US
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Telephone | 408-946-3296
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Fax | 408-946-3295
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Authorized Official
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Title or Position | CEO
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Name | MRS. RUTH A ARCIAGA
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Credential |
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Telephone | 408-941-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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