Healthcare Provider Details

I. General information

NPI: 1609266162
Provider Name (Legal Business Name): ALVIN K LOO DDS A DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50949 WASHINGTON ST UNIT G
LA QUINTA CA
92253-2890
US

IV. Provider business mailing address

50949 WASHINGTON ST UNIT G
LA QUINTA CA
92253-2890
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-0350
  • Fax: 760-564-0736
Mailing address:
  • Phone: 760-564-0350
  • Fax: 760-564-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. KWOR LOO
Title or Position: OWNER
Credential: DDS
Phone: 760-564-0350