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Organization
PLAYA VISTA DENTAL
Active
Organization
PLAYA VISTA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE FUNG DDS (OWNER)
(213) 453-3407
Entity
Organization
Contact information
Practice address
12975 AGUSTIN PL, #125, PLAYA VISTA, CA 90094-2307
(213) 453-3407
Mailing address
12975 AGUSTIN PL, #125, PLAYA VISTA, CA 90094-2307
(213) 453-3407
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60753
CA
Other
Enumeration date
06/19/2016
Last updated
06/19/2016
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