1720719859 NPI number — MICHAEL VINCENT LAUREOLA DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720719859 NPI number — MICHAEL VINCENT LAUREOLA DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL VINCENT LAUREOLA 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:
Provider Other Organization Name Type Code:
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:
1720719859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12121 WILSHIRE BLVD STE 1111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-1188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-820-9933
Provider Business Mailing Address Fax Number:
310-820-0408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10639 CARMENITA RD UNIT 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90670-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-820-9933
Provider Business Practice Location Address Fax Number:
310-820-0408
Provider Enumeration Date:
06/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
310-409-4225

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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