Provider Demographics
NPI:1609266162
Name:ALVIN K LOO DDS A DENTAL CORP
Entity Type:Organization
Organization Name:ALVIN K LOO DDS A DENTAL CORP
Other - Org Name:DENTAL SPECIALTY OF LA QUINTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KWOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-564-0350
Mailing Address - Street 1:50949 WASHINGTON ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2890
Mailing Address - Country:US
Mailing Address - Phone:760-564-0350
Mailing Address - Fax:760-564-0736
Practice Address - Street 1:50949 WASHINGTON ST UNIT G
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2890
Practice Address - Country:US
Practice Address - Phone:760-564-0350
Practice Address - Fax:760-564-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty