Provider Demographics
NPI:1457017105
Name:LOTUACO DENTAL CORPORATION
Entity Type:Organization
Organization Name:LOTUACO DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTUACO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:747-232-3847
Mailing Address - Street 1:13032 ANGELES TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3479
Mailing Address - Country:US
Mailing Address - Phone:747-232-3847
Mailing Address - Fax:
Practice Address - Street 1:2217 NILES PT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4023
Practice Address - Country:US
Practice Address - Phone:661-863-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental