Individual
DR. THERESIA LAKSMANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
925 W 34TH ST, LOS ANGELES, CA 90089-0641
(213) 740-2805
Mailing address
925 W 34TH ST, LOS ANGELES, CA 90089-0641
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
58149
CA
Other
Enumeration date
09/08/2009
Last updated
08/12/2011
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