Provider Demographics
NPI:1780842310
Name:MARIA LUISA CO DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARIA LUISA CO DDS PROFESSIONAL CORPORATION
Other - Org Name:LIVE OAK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA LUISA
Authorized Official - Middle Name:ALMAZAN
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-898-0008
Mailing Address - Street 1:288 E. LIVE OAK AVENUE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5629
Mailing Address - Country:US
Mailing Address - Phone:626-288-0008
Mailing Address - Fax:
Practice Address - Street 1:288 E LIVE OAK AVE UNIT C
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5629
Practice Address - Country:US
Practice Address - Phone:626-898-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty