1730467044 NPI number — LOURENCO DDS. INC

Table of content: (NPI 1730467044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730467044 NPI number — LOURENCO DDS. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOURENCO DDS. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MY TOOTH PLACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730467044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12112 BROOKHURST ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92840-2844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-539-7974
Provider Business Mailing Address Fax Number:
714-539-7976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12112 BROOKHURST STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-539-7974
Provider Business Practice Location Address Fax Number:
714-539-7976
Provider Enumeration Date:
08/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOURENCO
Authorized Official First Name:
AURY
Authorized Official Middle Name:
ARROYO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-539-7974

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  56298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)