Provider Demographics
NPI:1689861841
Name:TUOLUMNE COUNTY OFFICE OF EDUCATION
Entity Type:Organization
Organization Name:TUOLUMNE COUNTY OFFICE OF EDUCATION
Other - Org Name:SMILE KEEPERS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-533-2225
Mailing Address - Street 1:175 FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4809
Mailing Address - Country:US
Mailing Address - Phone:209-533-2225
Mailing Address - Fax:209-536-2003
Practice Address - Street 1:175 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4809
Practice Address - Country:US
Practice Address - Phone:209-533-2225
Practice Address - Fax:209-536-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)