Provider Demographics
NPI:1275684367
Name:LAO, THERESA (DDS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:LAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1N141 COUNTY FARM RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2032
Mailing Address - Country:US
Mailing Address - Phone:630-588-1700
Mailing Address - Fax:630-588-1700
Practice Address - Street 1:1990 ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-8974
Practice Address - Country:US
Practice Address - Phone:630-372-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0217161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice