Provider Demographics
NPI:1932496387
Name:LOUIS F. MASCOLA, D.D.S. AND JAMES LOOS, D.D.S., A PROFESSIONAL DENTAL
Entity Type:Organization
Organization Name:LOUIS F. MASCOLA, D.D.S. AND JAMES LOOS, D.D.S., A PROFESSIONAL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-856-6401
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:310-856-6401
Mailing Address - Fax:
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:310-856-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty