Provider Demographics
NPI:1356983696
Name:LAU, JEFFREY WAISING (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WAISING
Last Name:LAU
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W GATE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4867
Mailing Address - Country:US
Mailing Address - Phone:512-447-0808
Mailing Address - Fax:
Practice Address - Street 1:6700 W GATE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4867
Practice Address - Country:US
Practice Address - Phone:512-447-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist