Provider Demographics
NPI:1508915422
Name:DR. JOHN M. LEGASPI DMD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. JOHN M. LEGASPI DMD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-973-1525
Mailing Address - Street 1:13352 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5805
Mailing Address - Country:US
Mailing Address - Phone:310-973-1525
Mailing Address - Fax:310-973-1625
Practice Address - Street 1:13352 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5805
Practice Address - Country:US
Practice Address - Phone:310-973-1525
Practice Address - Fax:310-973-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID #