Provider Demographics
NPI:1184094310
Name:ARCHUNG & LAGATTA DDS, INC
Entity type:Organization
Organization Name:ARCHUNG & LAGATTA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ARCHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-343-6114
Mailing Address - Street 1:2493 N HIGHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6479
Mailing Address - Country:US
Mailing Address - Phone:714-343-6114
Mailing Address - Fax:
Practice Address - Street 1:10500 MAGNOLIA AVE
Practice Address - Street 2:STE A1
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5817
Practice Address - Country:US
Practice Address - Phone:714-343-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499191223G0001X
CA472271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty