Provider Demographics
NPI:1346385432
Name:ADAM G. LAUTT D.D.S., M.S., INC.
Entity Type:Organization
Organization Name:ADAM G. LAUTT D.D.S., M.S., INC.
Other - Org Name:COASTAL ORTHODONTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LAUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, INC
Authorized Official - Phone:805-650-1080
Mailing Address - Street 1:1730 S VICTORIA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6167
Mailing Address - Country:US
Mailing Address - Phone:805-650-1080
Mailing Address - Fax:805-650-1087
Practice Address - Street 1:1730 S VICTORIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6167
Practice Address - Country:US
Practice Address - Phone:805-650-1080
Practice Address - Fax:805-650-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental