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General NPI Number Information
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NPI Number | 1477858868
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Entity Type | Organization
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Legal Business Name | GIANCARLO A. LAURIENTE, DDS, INC.
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 02/25/2012
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Provider Practice Location Address
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Address Line | 2 JAMES WAY SUITE 201
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City | PISMO BEACH
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State | CA
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Zip | 93449-4973
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Country | US
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Telephone | 805-773-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 2 JAMES WAY SUITE 201
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City | PISMO BEACH
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State | CA
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Zip | 93449-4973
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Country | US
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Telephone | 805-773-1600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | GIANCARLO LAURIENTE
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Credential |
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Telephone | 805-773-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 57956
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 57956
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 55144
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License Number State | CA
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