| Theresia Laksmana - Dmd - Dental Corporation | |
|
12035 Lucile St Culver City CA 90230-6239 | |
| (310) 945-8382 | |
| Not Available |
| Full Name | Theresia Laksmana - Dmd - Dental Corporation |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 12035 Lucile St, Culver City, California |
| Authorized Official Name and Position | Theresia Laksmana (PRESIDENT) |
| Authorized Official Contact | 3109458382 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theresia Laksmana - Dmd - Dental Corporation 12035 Lucile St Culver City CA 90230-6239 Ph: (310) 945-8382 | Theresia Laksmana - Dmd - Dental Corporation 12035 Lucile St Culver City CA 90230-6239 Ph: (310) 945-8382 |
| NPI Number | 1124428271 |
|---|---|
| Provider Enumeration Date | 08/26/2014 |
| Last Update Date | 08/26/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124428271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 58149 (California) | Primary |
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