Provider Demographics
NPI:1780121624
Name:C. N. ZERTUCHE, INC., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:C. N. ZERTUCHE, INC., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEE ZERTUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-232-5846
Mailing Address - Street 1:3430 TULLY RD STE 20 #516
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0840
Mailing Address - Country:US
Mailing Address - Phone:209-232-5846
Mailing Address - Fax:
Practice Address - Street 1:3340 TULLY RD STE D3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0852
Practice Address - Country:US
Practice Address - Phone:209-232-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty