MEDICARE: LAU DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24820	CA
2	1223G0001X	General Practice Dentistry	21320	CA

General Provider Information

NPI Number	:	1003805649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAU DENTAL GROUP

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE #1608
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-481-1100
Fax Number	:	213-481-0998

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE #1608
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-481-1100
Fax Number	:	213-481-0998

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARL S LAU
Credential	:	D.D.S.
Telephone Number	:	213-481-1100

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	08/22/2020

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Directions to “LAU DENTAL GROUP ” Practice Location

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