Provider Demographics
NPI:1629361662
Name:LAO, JOO-ANN (DDS)
Entity Type:Individual
Prefix:
First Name:JOO-ANN
Middle Name:
Last Name:LAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TOWNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7538
Mailing Address - Country:US
Mailing Address - Phone:707-578-3721
Mailing Address - Fax:
Practice Address - Street 1:3757 CROSS CREEK RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0925
Practice Address - Country:US
Practice Address - Phone:707-525-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist