Provider Demographics
NPI:1588015556
Name:LAWRENCE M. LOZADA D.D.S. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE M. LOZADA D.D.S. PROFESSIONAL CORPORATION
Other - Org Name:PINNACLE PEAK DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOZADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-945-7915
Mailing Address - Street 1:945 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3428
Mailing Address - Country:US
Mailing Address - Phone:661-945-7915
Mailing Address - Fax:661-425-9590
Practice Address - Street 1:945 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3428
Practice Address - Country:US
Practice Address - Phone:661-945-7915
Practice Address - Fax:661-425-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty