Provider Demographics
NPI:1417177379
Name:LAC, JOSEPHINA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINA
Middle Name:
Last Name:LAC
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10164 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3303
Mailing Address - Country:US
Mailing Address - Phone:804-918-5850
Mailing Address - Fax:804-918-3901
Practice Address - Street 1:10164 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3303
Practice Address - Country:US
Practice Address - Phone:804-918-5850
Practice Address - Fax:804-918-3901
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04011026661223P0221X
MD137431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry