Provider Demographics
NPI:1184139933
Name:LO, LALEE CHIALONG (DDS)
Entity type:Individual
Prefix:DR
First Name:LALEE
Middle Name:CHIALONG
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 S 42ND PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7672
Mailing Address - Country:US
Mailing Address - Phone:951-312-4107
Mailing Address - Fax:
Practice Address - Street 1:1452 HUDSON ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3727
Practice Address - Country:US
Practice Address - Phone:360-425-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139321223G0001X
WADE610468551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice