Provider Demographics
NPI:1750811105
Name:LAU, ADAM HOWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HOWARD
Last Name:LAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W TROPICAL WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3328
Mailing Address - Country:US
Mailing Address - Phone:954-770-1716
Mailing Address - Fax:
Practice Address - Street 1:12781 MIRAMAR PKWY STE 306
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2908
Practice Address - Country:US
Practice Address - Phone:954-626-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice