Provider Demographics
NPI:1740422773
Name:JAYSON LO, D.M.D., INC.
Entity Type:Organization
Organization Name:JAYSON LO, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-293-7722
Mailing Address - Street 1:341 WESTLAKE CTR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1441
Mailing Address - Country:US
Mailing Address - Phone:650-293-7722
Mailing Address - Fax:
Practice Address - Street 1:341 WESTLAKE CTR
Practice Address - Street 2:SUITE 301
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1441
Practice Address - Country:US
Practice Address - Phone:650-293-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57177261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental