Provider Demographics
NPI:1164001798
Name:LAU VI DENTAL INC
Entity Type:Organization
Organization Name:LAU VI DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VI
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-465-1990
Mailing Address - Street 1:8600 LA MESA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9572
Mailing Address - Country:US
Mailing Address - Phone:619-465-1990
Mailing Address - Fax:
Practice Address - Street 1:8600 LA MESA BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9572
Practice Address - Country:US
Practice Address - Phone:619-465-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53037OtherDENTIST