Theresia Laksmana - Dmd - Dental Corporation
Dentist, Periodontics in Culver City, CA. Organization (NPI-2).
NPI number1124428271
StatusActive
Last updated in NPPESAug 26, 2014
Details
- NPI
- 1124428271
- Entity type
- Organization (NPI-2)
- Legal business name
- Theresia Laksmana - Dmd - Dental Corporation
- Organization subpart
- No
- Enumeration date
- Aug 26, 2014
- Last updated
- Aug 26, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | 58149 | CA | Yes |
Practice location
12035 Lucile StCulver City, CA 90230-6239
Phone 310-945-8382
Mailing address
12035 Lucile StCulver City, CA 90230-6239
Phone 310-945-8382
Authorized official
Theresia Laksmana
President
3109458382
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