Provider Demographics
NPI:1942601786
Name:ES KALEKA DMD INC
Entity Type:Organization
Organization Name:ES KALEKA DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDA
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:310-322-9476
Mailing Address - Street 1:502 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3201
Mailing Address - Country:US
Mailing Address - Phone:310-322-9476
Mailing Address - Fax:310-322-5224
Practice Address - Street 1:502 CENTER ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3201
Practice Address - Country:US
Practice Address - Phone:310-322-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty