Provider Demographics
NPI:1801154976
Name:L & S DENTAL CORP.
Entity type:Organization
Organization Name:L & S DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-955-6901
Mailing Address - Street 1:172 SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1434
Mailing Address - Country:US
Mailing Address - Phone:619-955-6901
Mailing Address - Fax:
Practice Address - Street 1:172 SIERRA WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1434
Practice Address - Country:US
Practice Address - Phone:619-955-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4090164302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization