Healthcare Provider Details

I. General information

NPI: 1003938630
Provider Name (Legal Business Name): MADEL P LACSON DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 E WASHINGTON BLVD SUITE #7
COMMERCE CA
90040-3960
US

IV. Provider business mailing address

5211 E WASHINGTON BLVD SUITE #7
COMMERCE CA
90040-3960
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-0000
  • Fax: 323-265-4442
Mailing address:
  • Phone: 323-267-0000
  • Fax: 323-265-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49353
License Number StateCA

VIII. Authorized Official

Name: DR. MADEL P LACSON
Title or Position: PRESIDENT DENTIST
Credential: DMD
Phone: 323-267-0000