Provider Demographics
NPI:1831892371
Name:LAB DMD LLC
Entity type:Organization
Organization Name:LAB DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENKAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-939-8020
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6636
Mailing Address - Country:US
Mailing Address - Phone:781-893-7500
Mailing Address - Fax:
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6636
Practice Address - Country:US
Practice Address - Phone:781-893-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental