MEDICARE: KWOK C LAU DMD

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	122300000X	Dentist	13552	MA

General Provider Information

NPI Number	:	1831214022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWOK C LAU DMD

Provider Business Mailing Address
First Line	:	65 HARRISON AVE
Second Line	:	#418
City	:	BOSTON
State	:	MA
Zip	:	02111-1924
Country	:	US
Telephone Number	:	617-451-0232
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 HARRISON AVE
Second Line	:	#418
City	:	BOSTON
State	:	MA
Zip	:	02111-1924
Country	:	US
Telephone Number	:	617-451-0232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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