Healthcare Provider Details

I. General information

NPI: 1316650906
Provider Name (Legal Business Name): LAB DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 2C
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

1180 BEACON ST STE 2C
BROOKLINE MA
02446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 617-860-1180
  • Fax:
Mailing address:
  • Phone: 617-860-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. WENKAI KAO
Title or Position: CEO
Credential: DMD
Phone: 617-939-8020