Provider Demographics
NPI:1053964072
Name:JOHN C. TRUEB, DDS, INC.
Entity type:Organization
Organization Name:JOHN C. TRUEB, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TRUEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-823-3574
Mailing Address - Street 1:165 SAINT DOMINICS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7802
Mailing Address - Country:US
Mailing Address - Phone:209-823-3574
Mailing Address - Fax:209-239-4378
Practice Address - Street 1:165 SAINT DOMINICS DR STE 100
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7802
Practice Address - Country:US
Practice Address - Phone:209-823-3574
Practice Address - Fax:209-239-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies