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General NPI Number Information
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NPI Number | 1063896587
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Entity Type | Individual
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Provider Name | LAURITA SIU DDS, MPH
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 1001 SHADOW LN
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City | LAS VEGAS
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State | NV
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Zip | 89106-4124
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Country | US
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Telephone | 702-774-2416
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Fax |
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Provider Business Mailing Address
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Address Line | 12821 MAIN ST.
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City | HESPERIA
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State | CA
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Zip | 92345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS101380
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License Number State | CA
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