Organization
CONVALESCENT DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALGIS V. LASAS (SOLE PROPRIETOR)
(310) 215-9156
Entity
Organization
Contact information
Practice address
6226 HALF W MANCHESTER AVE, LOS ANGELES, CA 90045
(310) 215-9156
Mailing address
6226 1 HALF W. MANCHESTER AVE., LOS ANGELES, CA 90045
(310) 215-9156
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20552
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B20552
—
CA
05
—
B20552-01
—
CA
Enumeration date
01/25/2007
Last updated
04/12/2012
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