# MIKE'S DENTAL LAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134493943
- **Authorized official:** MR. MICHAEL J TETRICK CDT (CERTIFIED DENTAL TECHNICIAN)
- **Authorized official phone:** (916) 487-2236

## Contact information

- **Practice address:** 1735 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
- **Practice address phone:** (916) 487-2236
- **Mailing address:** 1735 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
- **Mailing address phone:** (916) 487-2236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | 347527 | CA | Yes |

## Other

- **Enumeration date:** 02/27/2012
- **Last updated:** 02/27/2012