Provider Demographics
NPI:1104030253
Name:HA, LAWRENCE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:T
Last Name:HA
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 1:6038 MONTEMALAGA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1751
Mailing Address - Country:US
Mailing Address - Phone:310-377-9496
Mailing Address - Fax:
Practice Address - Street 1:2525 WESTMINSTER AVE
Practice Address - Street 2:STE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2143
Practice Address - Country:US
Practice Address - Phone:714-554-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist