Provider Demographics
NPI:1790794758
Name:TRUEB, JOHN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:TRUEB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ST. DOMINIC DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7801
Mailing Address - Country:US
Mailing Address - Phone:209-823-3574
Mailing Address - Fax:209-239-4378
Practice Address - Street 1:165 ST. DOMINIC DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7801
Practice Address - Country:US
Practice Address - Phone:209-823-3574
Practice Address - Fax:209-239-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice