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Organization
LEA BANGSIL DMD INC
Active
Organization
LEA BANGSIL DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEA BANGSIL (PRESIDENT)
(562) 690-5261
Entity
Organization
Contact information
Practice address
548 W LA HABRA BLVD, LA HABRA, CA 90631-5308
(562) 690-5261
Mailing address
548 W LA HABRA BLVD, LA HABRA, CA 90631-5308
(562) 690-5261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
B40532
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B40532-01
DENTI-CAL
CA
Enumeration date
05/09/2006
Last updated
02/06/2015
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