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General NPI Number Information
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NPI Number | 1881002442
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Entity Type | Organization
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Legal Business Name | JOHN C. TRUEB, DDS
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 165 SAINT DOMINICS DR SUITE 100
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City | MANTECA
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State | CA
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Zip | 95337-7802
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Country | US
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Telephone | 209-823-3574
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Fax | 209-239-4378
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Provider Business Mailing Address
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Address Line | 165 SAINT DOMINICS DR SUITE 100
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City | MANTECA
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State | CA
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Zip | 95337-7802
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Country | US
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Telephone | 209-823-3574
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Fax | 209-239-4378
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN CHARLES TRUEB
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Credential | DDS
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Telephone | 209-823-3574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30949
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License Number State | CA
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