Provider Demographics
NPI:1760509509
Name:LAU, JOSEPH S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 MERCER UNIVERSITY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4145
Mailing Address - Country:US
Mailing Address - Phone:770-817-9400
Mailing Address - Fax:
Practice Address - Street 1:3020 MERCER UNIVERSITY DR
Practice Address - Street 2:SUITE#200
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4145
Practice Address - Country:US
Practice Address - Phone:770-817-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist