Provider Demographics
NPI:1508854241
Name:LAI, SHUFANG AMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHUFANG
Middle Name:AMY
Last Name:LAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2442 SE 101ST AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:94216-3060
Mailing Address - Country:US
Mailing Address - Phone:503-253-7579
Mailing Address - Fax:503-253-7579
Practice Address - Street 1:2442 SE 101ST AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3060
Practice Address - Country:US
Practice Address - Phone:503-253-7579
Practice Address - Fax:503-253-7579
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR066321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics