Healthcare Provider Details

I. General information

NPI: 1902732118
Provider Name (Legal Business Name): BENJAMIN LAU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 W ARROW HWY
SAN DIMAS CA
91773-2420
US

IV. Provider business mailing address

926 LAURYN RIDGE CT
MILPITAS CA
95035-6685
US

V. Phone/Fax

Practice location:
  • Phone: 909-592-5599
  • Fax:
Mailing address:
  • Phone: 408-833-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: