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General NPI Number Information
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NPI Number | 1922514819
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Entity Type | Organization
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Legal Business Name | LARCHMONT VILLAGE DENTAL SPECIALTY CENTER, INC.
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD STE 721
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City | LOS ANGELES
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State | CA
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Zip | 90004-6407
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Country | US
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Telephone | 323-465-3116
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N LARCHMONT BLVD STE 721
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City | LOS ANGELES
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State | CA
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Zip | 90004-6407
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Country | US
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Telephone | 323-465-3116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KWOR CHIEH LOO
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Credential | DDS
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Telephone | 626-475-7424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DDS45489
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License Number State | CA
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