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General NPI Number Information
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NPI Number | 1538221742
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Entity Type | Individual
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Provider Name | MICHAEL VINCENT LAUREOLA DDS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3635 E 1ST ST
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City | LOS ANGELES
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State | CA
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Zip | 90063-2345
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Country | US
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Telephone | 323-269-7367
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Fax |
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Provider Business Mailing Address
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Address Line | 2265 LANGSPUR DR
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-5732
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Country | US
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Telephone | 562-266-7079
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 55121
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License Number State | CA
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