Provider Demographics
NPI:1730467044
Name:LOURENCO DDS. INC
Entity Type:Organization
Organization Name:LOURENCO DDS. INC
Other - Org Name:MY TOOTH PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURY
Authorized Official - Middle Name:ARROYO
Authorized Official - Last Name:LOURENCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-539-7974
Mailing Address - Street 1:12112 BROOKHURST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2844
Mailing Address - Country:US
Mailing Address - Phone:714-539-7974
Mailing Address - Fax:714-539-7976
Practice Address - Street 1:12112 BROOKHURST STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2844
Practice Address - Country:US
Practice Address - Phone:714-539-7974
Practice Address - Fax:714-539-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56298261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental