Provider Demographics
NPI:1356731608
Name:MAN-PIK LO, D.D.S., INC.
Entity type:Organization
Organization Name:MAN-PIK LO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAN-PIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-863-0388
Mailing Address - Street 1:20395 PACIFICA DRIVE, STE. 110
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-863-0388
Mailing Address - Fax:408-863-0628
Practice Address - Street 1:20395 PACIFICA DRIVE, STE. 110
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-863-0388
Practice Address - Fax:408-863-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty