Provider Demographics
NPI:1457421752
Name:LAKSANA, DANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANI
Middle Name:
Last Name:LAKSANA
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 1:4426 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2208
Mailing Address - Country:US
Mailing Address - Phone:510-222-1621
Mailing Address - Fax:510-222-1626
Practice Address - Street 1:4426 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-2208
Practice Address - Country:US
Practice Address - Phone:510-222-1621
Practice Address - Fax:510-222-1626
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4234801OtherMEDI CAL DENTI CAL