Provider Demographics
NPI:1376892810
Name:ODONO, LAUREN TOMIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:TOMIKO
Last Name:ODONO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 W BEVERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1540
Mailing Address - Country:US
Mailing Address - Phone:323-721-7993
Mailing Address - Fax:323-721-5571
Practice Address - Street 1:3523 W BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1540
Practice Address - Country:US
Practice Address - Phone:323-721-7993
Practice Address - Fax:323-721-5571
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice