Provider Demographics
NPI:1023257458
Name:PROSTHESIS DENTAL LABORATORY, INC.
Entity type:Organization
Organization Name:PROSTHESIS DENTAL LABORATORY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARCIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-941-9257
Mailing Address - Street 1:1350 S PARK VICTORIA DR STE 41
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6941
Mailing Address - Country:US
Mailing Address - Phone:408-946-3296
Mailing Address - Fax:408-946-3295
Practice Address - Street 1:1350 S PARK VICTORIA DR STE 41
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6941
Practice Address - Country:US
Practice Address - Phone:408-946-3296
Practice Address - Fax:408-946-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty