Provider Demographics
NPI:1689776155
Name:LAW, CATHY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:A
Last Name:LAW
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 1:1152 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3669
Mailing Address - Country:US
Mailing Address - Phone:909-946-6868
Mailing Address - Fax:
Practice Address - Street 1:1152 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3669
Practice Address - Country:US
Practice Address - Phone:909-946-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice