Provider Demographics
NPI:1477950194
Name:LAI, DENNIS QUINTIN (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:QUINTIN
Last Name:LAI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:QUINTIN
Other - Middle Name:
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2308 W HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-6729
Mailing Address - Country:US
Mailing Address - Phone:918-968-0079
Mailing Address - Fax:
Practice Address - Street 1:2308 W HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-6729
Practice Address - Country:US
Practice Address - Phone:918-968-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant