Martin W. Laksana DDS Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

B35512 Issued in CA

Legal business name

MARTIN W. LAKSANA DDS INC

Practice address

130 S. Mountain Ave.
#G
Upland, CA 91786-6269

Phone

(909) 949-7002

NPI assigned

Aug 20, 2009

Organization subpart

No

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

Authorized official

Name

Martin W Laksana, DDSNPI 1295894061

Title

President

Phone

(909) 949-7002

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martin Winata Laksana, D.D.S.

  • General Practice Dentistry
  • Upland, CA
  • NPI 1295894061
  NPD (past) Authorized official

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1932331246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 S. MOUNTAIN AVE.",
            "address_2": "#G",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866269",
            "telephone_number": "909-949-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S. MOUNTAIN AVE.",
            "address_2": "#G",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866269",
            "telephone_number": "909-949-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN W. LAKSANA DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "LAKSANA",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-949-7002",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "B35512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mario a Diaz-Gomez, M.D., a Professional Corporation
• Mark Waterman Chiropractic Corporation
• Neil Markley
• James Richard Marrone, MD
• Sheila Marshall, LMFT
• Donna Martin
• Kendal Martindale, MSW, ASW
• Martinez Dental Corporation
• Brenda Martinez Rios
• Alexandria Marie Martinez

• General Practice Dentistry in Upland, CA
• Providers in Upland, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; 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.