Provider Demographics
NPI:1619461761
Name:LAI, CONNIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:LAI
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 1:9 HOLBROOK CT
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1424
Mailing Address - Country:US
Mailing Address - Phone:973-270-8983
Mailing Address - Fax:
Practice Address - Street 1:9 HOLBROOK CT
Practice Address - Street 2:
Practice Address - City:TOWACO
Practice Address - State:NJ
Practice Address - Zip Code:07082-1424
Practice Address - Country:US
Practice Address - Phone:973-270-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027178001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics