Provider Demographics
NPI:1811199771
Name:LAU, ALICE
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9017 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1301
Mailing Address - Country:US
Mailing Address - Phone:301-921-8899
Mailing Address - Fax:
Practice Address - Street 1:9017 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-921-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist