Organization
GIANCARLO A. LAURIENTE, DDS, INC.
Active
Other names
Five Cities Pediatric Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
GIANCARLO LAURIENTE (PRESIDENT/CEO)
(805) 773-1600
Entity
Organization
Contact information
Practice address
2 JAMES WAY, SUITE 201, PISMO BEACH, CA 93449-4973
(805) 773-1600
Mailing address
2 JAMES WAY, SUITE 201, PISMO BEACH, CA 93449-4973
(805) 773-1600
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
55144
CA
1223P0221X
Pediatric Dentistry
57956
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
57956
CA
Other
Enumeration date
01/17/2011
Last updated
02/25/2012
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