Provider Demographics
NPI:1457545642
Name:LAPTALO, LISA NIELSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:NIELSEN
Last Name:LAPTALO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5702
Mailing Address - Country:US
Mailing Address - Phone:916-221-4321
Mailing Address - Fax:
Practice Address - Street 1:3461 FAIR OAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5702
Practice Address - Country:US
Practice Address - Phone:916-221-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist