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Organization
MIKE'S DENTAL LAB
Active
Organization
MIKE'S DENTAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J TETRICK CDT (CERTIFIED DENTAL TECHNICIAN)
(916) 487-2236
Entity
Organization
Contact information
Practice address
1735 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
(916) 487-2236
Mailing address
1735 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
(916) 487-2236
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
347527
CA
Other
Enumeration date
02/27/2012
Last updated
02/27/2012
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