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General NPI Number Information
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NPI Number | 1972817427
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Entity Type | Organization
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Legal Business Name | I.RICHARD MASSOTH, DDS, LISE LAFLAMME, DMD
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 5567 RESEDA BLVD STE 100
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City | TARZANA
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State | CA
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Zip | 91356-2648
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Country | US
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Telephone | 818-705-1274
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Fax | 818-705-6782
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Provider Business Mailing Address
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Address Line | 5567 RESEDA BLVD STE 100
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City | TARZANA
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State | CA
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Zip | 91356-2648
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Country | US
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Telephone | 818-705-1274
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Fax | 818-705-6782
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Authorized Official
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Title or Position | DDS, MSD
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Name | DR. RICHARD MASSOTH
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Credential |
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Telephone | 818-705-1274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 28957
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License Number State | CA
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