Provider Demographics
NPI:1760946719
Name:CALA, LUCAS ALFREDO (DDS)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ALFREDO
Last Name:CALA
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 1:5259 MONET CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6129
Mailing Address - Country:US
Mailing Address - Phone:619-496-5916
Mailing Address - Fax:
Practice Address - Street 1:200 N ASH ST STE 200
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3024
Practice Address - Country:US
Practice Address - Phone:760-738-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist