Provider Demographics
NPI:1043818610
Name:JESSICA LAU DMD PLLC
Entity Type:Organization
Organization Name:JESSICA LAU DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-208-6488
Mailing Address - Street 1:345 HARRISON AVE APT 827
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3080
Mailing Address - Country:US
Mailing Address - Phone:650-208-6488
Mailing Address - Fax:
Practice Address - Street 1:800 BOYLSTON ST FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-8081
Practice Address - Country:US
Practice Address - Phone:617-829-9744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty