Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 31831 | CA |
NPI | 1003241548 |
---|---|
Provider Name | Dr. Edward A Mclaren |
First Address | Los Angeles, CA 90024-3309 |
Second Address | Los Angeles, CA 90024-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/09/2013 |