Healthcare Provider Details

I. General information

NPI: 1932496387
Provider Name (Legal Business Name): LOUIS F. MASCOLA, D.D.S. AND JAMES LOOS, D.D.S., A PROFESSIONAL DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W 9TH ST
SAN PEDRO CA
90731-3602
US

IV. Provider business mailing address

770 W 9TH ST
SAN PEDRO CA
90731-3602
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-6401
  • Fax:
Mailing address:
  • Phone: 310-856-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LOUIS F MASCOLA
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-856-6401