Provider Demographics
NPI:1336573476
Name:LALA, SANJAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:LALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist