Provider Demographics
NPI:1346351558
Name:LAC, ERIC VY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:VY
Last Name:LAC
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 1:72 PINE BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2778
Mailing Address - Country:US
Mailing Address - Phone:702-248-0081
Mailing Address - Fax:702-248-7123
Practice Address - Street 1:10170 W TROPICANA AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8465
Practice Address - Country:US
Practice Address - Phone:702-248-0081
Practice Address - Fax:702-248-7123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4563OtherSTATE DENTAL LICENSE