Organization
THERESIA LAKSMANA - DMD - DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESIA LAKSMANA DMD (PRESIDENT)
(310) 945-8382
Entity
Organization
Contact information
Practice address
12035 LUCILE ST, CULVER CITY, CA 90230-6239
(310) 945-8382
Mailing address
12035 LUCILE ST, CULVER CITY, CA 90230-6239
(310) 945-8382
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
58149
CA
Other
Enumeration date
08/26/2014
Last updated
08/26/2014
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