Healthcare Provider Details

I. General information

NPI: 1851212989
Provider Name (Legal Business Name): LAWRENCE T HA DDS, DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S. BROADWAY
SANTA ANA CA
92707
US

IV. Provider business mailing address

1506 S. BROADWAY
SANTA ANA CA
92707
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-9718
  • Fax:
Mailing address:
  • Phone: 714-543-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE T HA
Title or Position: CEO
Credential: DDS
Phone: 714-543-9718