Organization
DENTAL WEAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIE LIVOLSI (PRESIDENT)
(562) 279-5770
Entity
Organization
Contact information
Practice address
1401 E 4TH ST, SUITE A, LONG BEACH, CA 90802-1800
(562) 279-5770
Mailing address
1401 E 4TH ST, SUITE A, LONG BEACH, CA 90802-1800
(562) 279-5770
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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