Provider Demographics
NPI:1669649323
Name:LO, TAKBIU (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAKBIU
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34400 DATE PALM DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6837
Mailing Address - Country:US
Mailing Address - Phone:760-770-8009
Mailing Address - Fax:
Practice Address - Street 1:34400 DATE PALM DR
Practice Address - Street 2:SUITE H
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6837
Practice Address - Country:US
Practice Address - Phone:760-770-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice