Provider Demographics
NPI:1023650983
Name:LAGDA PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:LAGDA PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LADGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-433-1300
Mailing Address - Street 1:1830 OCEANSIDE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3400
Mailing Address - Country:US
Mailing Address - Phone:760-433-1300
Mailing Address - Fax:760-433-1331
Practice Address - Street 1:1830 OCEANSIDE BLVD STE D
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3400
Practice Address - Country:US
Practice Address - Phone:760-433-1300
Practice Address - Fax:760-433-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty