Provider Demographics
NPI:1164055703
Name:JAMES LAGATTA DDS INC
Entity Type:Organization
Organization Name:JAMES LAGATTA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-773-6057
Mailing Address - Street 1:6860 E AVENIDA DE SANTIAGO
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-5102
Mailing Address - Country:US
Mailing Address - Phone:562-773-6057
Mailing Address - Fax:
Practice Address - Street 1:9444 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-773-6057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073683900Medicaid