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General NPI Number Information
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NPI Number | 1184139933
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Entity Type | Individual
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Provider Name | LALEE CHIALONG LO DDS
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Gender | Male
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1452 HUDSON ST STE 200
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City | LONGVIEW
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State | WA
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Zip | 98632-3727
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Country | US
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Telephone | 360-425-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 3733 S 42ND PL
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City | RIDGEFIELD
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State | WA
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Zip | 98642-7672
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Country | US
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Telephone | 951-312-4107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D13932
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE61046855
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License Number State | WA
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