=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013192467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. MASSOTH, DDS, L. LAFLAMME, DMD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2008
-----------------------------------------------------
Last Update Date | 01/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4910 VAN NUYS BLVD #100
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-783-5234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4910 VAN NUYS BLVD #100
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-783-5234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | JENNIFER COONEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-783-5234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 28957
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------