Provider Demographics
NPI:1811943814
Name:LAU, SALLIE MCLANE (DMD)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:MCLANE
Last Name:LAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SALLIE
Other - Middle Name:ANN
Other - Last Name:MCLANE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:522 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-947-1525
Mailing Address - Fax:
Practice Address - Street 1:522 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-947-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice