# PRODENT DENTAL LAB

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

## Provider details

- **NPI number:** 1477884641
- **Authorized official:** MR. PERCIVAL MAGPUSAO MANZANO MDT (LAB TECHNICIAN)
- **Authorized official phone:** (707) 655-8824

## Contact information

- **Practice address:** 3000 ALAMO DR STE 108, VACAVILLE, CA 95687-6345
- **Practice address phone:** (707) 655-8824
- **Mailing address:** 3000 ALAMO DR STE 108, VACAVILLE, CA 95687-6345
- **Mailing address phone:** (707) 655-8824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | 016761 | CA | Yes |

## Other

- **Enumeration date:** 01/27/2010
- **Last updated:** 01/28/2010