Provider Demographics
NPI:1720214059
Name:GAO, LAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:
Last Name:GAO
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 1:4095 SW 144TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2368
Mailing Address - Country:US
Mailing Address - Phone:503-643-4719
Mailing Address - Fax:503-626-9488
Practice Address - Street 1:4095 SW 144TH AVE STE A
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2368
Practice Address - Country:US
Practice Address - Phone:503-643-4719
Practice Address - Fax:503-626-9488
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist