Provider Demographics
NPI:1205242906
Name:LAU, KENT (DDS)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
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 1:405 W FOOTHILL BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2786
Mailing Address - Country:US
Mailing Address - Phone:909-626-1236
Mailing Address - Fax:
Practice Address - Street 1:405 W FOOTHILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2786
Practice Address - Country:US
Practice Address - Phone:909-626-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist