Organization
PRODENT DENTAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PERCIVAL MAGPUSAO MANZANO MDT (LAB TECHNICIAN)
(707) 655-8824
Entity
Organization
Contact information
Practice address
3000 ALAMO DR STE 108, VACAVILLE, CA 95687-6345
(707) 655-8824
Mailing address
3000 ALAMO DR STE 108, VACAVILLE, CA 95687-6345
(707) 655-8824
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
016761
CA
Other
Enumeration date
01/27/2010
Last updated
01/28/2010
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