Provider Demographics
NPI:1235710013
Name:LACSON, CHLOE CATHERINE COO (RDH, RDHAP, DDS)
Entity Type:Individual
Prefix:DR
First Name:CHLOE CATHERINE
Middle Name:COO
Last Name:LACSON
Suffix:
Gender:F
Credentials:RDH, RDHAP, DDS
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:LACDAN
Other - Last Name:COO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH, RDHAP
Mailing Address - Street 1:12345 MOUNTAIN AVE STE O
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2783
Mailing Address - Country:US
Mailing Address - Phone:909-364-1330
Mailing Address - Fax:
Practice Address - Street 1:12345 MOUNTAIN AVE STE O
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2783
Practice Address - Country:US
Practice Address - Phone:909-364-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH27436124Q00000X
CA106870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist