Provider Demographics
NPI:1891986345
Name:LOUIS F MASCOLA DDS INC
Entity Type:Organization
Organization Name:LOUIS F MASCOLA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MASCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-831-2377
Mailing Address - Street 1:770 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3602
Mailing Address - Country:US
Mailing Address - Phone:310-831-2377
Mailing Address - Fax:310-831-0561
Practice Address - Street 1:770 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3602
Practice Address - Country:US
Practice Address - Phone:310-831-2377
Practice Address - Fax:310-831-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty