Provider Demographics
NPI:1518171867
Name:LAU, TINA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:S
Last Name:LAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:UNIVERSITY DENTISTS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2820
Mailing Address - Country:US
Mailing Address - Phone:860-748-3444
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:UNIVERSITY DENTISTS
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2820
Practice Address - Country:US
Practice Address - Phone:860-679-3170
Practice Address - Fax:860-679-8162
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice