Provider Demographics
NPI:1891968012
Name:MAILIN MIMI LAI, D.D.S., P.C.
Entity Type:Organization
Organization Name:MAILIN MIMI LAI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAILIN
Authorized Official - Middle Name:MIMI
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-227-3088
Mailing Address - Street 1:11 E BROADWAY
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1013
Mailing Address - Country:US
Mailing Address - Phone:212-227-3088
Mailing Address - Fax:212-227-3866
Practice Address - Street 1:11 E BROADWAY
Practice Address - Street 2:13TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1013
Practice Address - Country:US
Practice Address - Phone:212-227-3088
Practice Address - Fax:212-227-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635110Medicaid
NY03047812Medicaid
NY03822200Medicaid
NY02883778Medicaid
NY02587759Medicaid
NY03072566Medicaid
NY013560506Medicaid
NY010911258Medicaid
NY02756389Medicaid
NY02901664Medicaid