Provider Demographics
NPI:1972727014
Name:SANJAY LALA DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SANJAY LALA DDS, A PROFESSIONAL CORPORATION
Other - Org Name:LAUREL CHANDLER DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-508-2250
Mailing Address - Street 1:5000 VAN NUYS BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1717
Mailing Address - Country:US
Mailing Address - Phone:818-508-2250
Mailing Address - Fax:818-762-0681
Practice Address - Street 1:5000 VAN NUYS BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1717
Practice Address - Country:US
Practice Address - Phone:818-508-2250
Practice Address - Fax:818-762-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA517741OtherMEDI CAL