Theresia Laksmana - DMD - Dental Corporation

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

58149 Issued in CA

Legal business name

THERESIA LAKSMANA - DMD - DENTAL CORPORATION

Practice address

12035 Lucile St
Culver City, CA 90230-6239

Phone

(310) 945-8382

NPI assigned

Aug 26, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theresia Laksmana, DMD

Title

President

Phone

(310) 945-8382

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1124428271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12035 LUCILE ST",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306239",
            "telephone_number": "310-945-8382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12035 LUCILE ST",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306239",
            "telephone_number": "310-945-8382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESIA LAKSMANA - DMD - DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "LAKSMANA",
        "authorized_official_first_name": "THERESIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-945-8382",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "58149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Center for the Partially Sighted
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• The Regents of the University of California (UCLA Dept of Medicine)
• Therabloom Family Counseling Inc
• Yaso A Thiagarajah
• Amy Thiel
• Linda R Thierry, RN
• Artemis Thomas-Hansard
• Allen Adolphus Thomas III, D.C., Q.M.E.

• Periodontics in Culver City, CA
• Providers in Culver City, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.