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NPI Code Detail

MEDICARE: DR. MICHAEL VINCENT LAUREOLA DDS

MEDICARE: DR. MICHAEL VINCENT LAUREOLA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry55121CA

General Provider Information

NPI Number : 1538221742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL VINCENT LAUREOLA DDS
Provider Business Mailing Address
First Line : 2265 LANGSPUR DR
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-5732
Country : US
Telephone Number : 562-266-7079
Fax Number :
Provider Business Practice Location Address
First Line : 3635 E 1ST ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-2345
Country : US
Telephone Number : 323-269-7367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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