Provider Demographics
NPI:1871281634
Name:LA, CASEY CHING (DMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:CHING
Last Name:LA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12448 ORANGEBLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7057
Mailing Address - Country:US
Mailing Address - Phone:951-329-0372
Mailing Address - Fax:
Practice Address - Street 1:12448 ORANGEBLOSSOM LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-7057
Practice Address - Country:US
Practice Address - Phone:951-329-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1090061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program