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General NPI Number Information
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NPI Number | 1801154976
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Entity Type | Organization
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Legal Business Name | L & S DENTAL CORP.
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 172 SIERRA WAY
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City | CHULA VISTA
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State | CA
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Zip | 91911-1434
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Country | US
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Telephone | 619-955-6901
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Fax |
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Provider Business Mailing Address
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Address Line | 172 SIERRA WAY
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City | CHULA VISTA
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State | CA
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Zip | 91911-1434
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Country | US
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Telephone | 619-955-6901
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MARIO LAMAS
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Credential | DDS
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Telephone | 619-955-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 4090164
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 4090164
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License Number State | CA
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