Organization
MICHAEL VINCENT LAUREOLA DDS INC
Active
Other names
MAGICLAND DENTAL GROUP OF RANCHO DOMINGUEZ
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL REYES (Q/A CONTRACT & COMPLIANCE MANAGER)
(310) 409-4225
Entity
Organization
Contact information
Practice address
1633 S ALAMEDA ST STE 101, COMPTON, CA 90220-4976
(310) 820-9933
(310) 820-0408
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 409-4225
(310) 820-0408
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
01/21/2021
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