Healthcare Provider Details

I. General information

NPI: 1730347204
Provider Name (Legal Business Name): FRANK LAALY DDS, FICOI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FARZAN FRANK LAALY DDS

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19228 VENTURA BLVD STE A
TARZANA CA
91356-3101
US

IV. Provider business mailing address

442 N LA CIENEGA BLVD STE 208
WEST HOLLYWOOD CA
90048-1934
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-5125
  • Fax:
Mailing address:
  • Phone: 310-714-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number56900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: