Provider Demographics
NPI:1952461725
Name:JOSE EDUARDO LARA DDS INC
Entity Type:Organization
Organization Name:JOSE EDUARDO LARA DDS INC
Other - Org Name:ATWOOD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-993-2768
Mailing Address - Street 1:1651 E ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6629
Mailing Address - Country:US
Mailing Address - Phone:714-993-2768
Mailing Address - Fax:714-993-2775
Practice Address - Street 1:1651 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6629
Practice Address - Country:US
Practice Address - Phone:714-993-2768
Practice Address - Fax:714-993-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty