Provider Demographics
NPI:1447401922
Name:LAU, LAWRENCE (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LAU
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 1:8848 CALVINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-9334
Mailing Address - Country:US
Mailing Address - Phone:916-307-6035
Mailing Address - Fax:
Practice Address - Street 1:8848 CALVINE RD STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-9334
Practice Address - Country:US
Practice Address - Phone:916-307-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice