=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174839922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASCOLA, NAKATA & ASSOCIATES DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2010
-----------------------------------------------------
Last Update Date | 08/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19000 HAWTHORNE BLVD SUITE 400
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-773-5950
-----------------------------------------------------
Fax | 310-347-4099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19000 HAWTHORNE BLVD SUITE 400
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-773-5950
-----------------------------------------------------
Fax | 310-347-4099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LOUIS FRANK MASCOLA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 310-773-5950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19931
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------