Provider Demographics
NPI:1609649060
Name:CHLOE COO LACSON DDS INC
Entity Type:Organization
Organization Name:CHLOE COO LACSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE CATHERINE
Authorized Official - Middle Name:COO
Authorized Official - Last Name:LACSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-202-9746
Mailing Address - Street 1:12345 MOUNTAIN AVE STE O
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2783
Mailing Address - Country:US
Mailing Address - Phone:909-364-1330
Mailing Address - Fax:
Practice Address - Street 1:12345 MOUNTAIN AVE STE O
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2783
Practice Address - Country:US
Practice Address - Phone:909-364-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental