Provider Demographics
NPI:1093975146
Name:LW INC
Entity Type:Organization
Organization Name:LW INC
Other - Org Name:MISSION VIEJO DENTAL ASOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-586-6200
Mailing Address - Street 1:25522 MARGUERITE PKWY
Mailing Address - Street 2:STE #100
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692
Mailing Address - Country:US
Mailing Address - Phone:949-586-6200
Mailing Address - Fax:949-586-2791
Practice Address - Street 1:25522 MARGUERITE PARKWAY
Practice Address - Street 2:SUITE #100
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692
Practice Address - Country:US
Practice Address - Phone:949-586-6200
Practice Address - Fax:949-586-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21292261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental