Provider Demographics
NPI:1558657528
Name:SIMI ROYAL DENTAL CENTER
Entity Type:Organization
Organization Name:SIMI ROYAL DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LASCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-526-8637
Mailing Address - Street 1:1987 ROYAL AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:805-526-8637
Mailing Address - Fax:805-578-2307
Practice Address - Street 1:1987 ROYAL AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-526-8637
Practice Address - Fax:805-578-2307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMI ROYAL DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty