Provider Demographics
NPI:1578349817
Name:LUZURIAGA-BANGLOY DENTAL INC.
Entity Type:Organization
Organization Name:LUZURIAGA-BANGLOY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYZA
Authorized Official - Middle Name:LUZURIAGA
Authorized Official - Last Name:BANGLOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-519-7121
Mailing Address - Street 1:5250 SANTA MONICA BLVD STE 208B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1254
Mailing Address - Country:US
Mailing Address - Phone:323-662-3168
Mailing Address - Fax:
Practice Address - Street 1:5250 SANTA MONICA BLVD STE 208B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1254
Practice Address - Country:US
Practice Address - Phone:323-662-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental