Provider Demographics
NPI:1801465943
Name:LAI, NATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:LAI
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 1:1000 23RD AVE BLDG 914
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93043-4300
Mailing Address - Country:US
Mailing Address - Phone:805-982-5584
Mailing Address - Fax:
Practice Address - Street 1:1000 23RD AVE BLDG 914
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-4300
Practice Address - Country:US
Practice Address - Phone:805-982-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-52791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice