Provider Demographics
NPI:1952597775
Name:LAI, ANDREW THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
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 1:231 SE BARRINGTON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3200
Mailing Address - Country:US
Mailing Address - Phone:360-682-5488
Mailing Address - Fax:360-720-2926
Practice Address - Street 1:2105 CONTINENTAL PL STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4104
Practice Address - Country:US
Practice Address - Phone:360-848-7473
Practice Address - Fax:360-848-6585
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00097681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice