Provider Demographics
NPI:1730347204
Name:LAALY, FRANK (DDS, FICOI)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:LAALY
Suffix:
Gender:M
Credentials:DDS, FICOI
Other - Prefix:DR
Other - First Name:FARZAN
Other - Middle Name:FRANK
Other - Last Name:LAALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:442 N LA CIENEGA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1934
Mailing Address - Country:US
Mailing Address - Phone:310-714-3691
Mailing Address - Fax:
Practice Address - Street 1:19228 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3101
Practice Address - Country:US
Practice Address - Phone:818-578-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569001223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist