Provider Demographics
NPI:1972817427
Name:I.RICHARD MASSOTH, DDS, LISE LAFLAMME, DMD
Entity type:Organization
Organization Name:I.RICHARD MASSOTH, DDS, LISE LAFLAMME, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS, MSD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-705-1274
Mailing Address - Street 1:5567 RESEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2648
Mailing Address - Country:US
Mailing Address - Phone:818-705-1274
Mailing Address - Fax:818-705-6782
Practice Address - Street 1:5567 RESEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2648
Practice Address - Country:US
Practice Address - Phone:818-705-1274
Practice Address - Fax:818-705-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty