Provider Demographics
NPI:1073683900
Name:LAGATTA, JOSHUA JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:LAGATTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 CESAR E CHAVEZ AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063
Mailing Address - Country:US
Mailing Address - Phone:562-773-6057
Mailing Address - Fax:
Practice Address - Street 1:3710 CESAR E CHAVEZ AVE SUITE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063
Practice Address - Country:US
Practice Address - Phone:562-773-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93176-01OtherDENTIACAL (MEDICAL)
CAG93176-02OtherMEDICAL-DENTAL
CAG93176-03Medicaid