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General NPI Number Information
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NPI Number | 1720420979
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Entity Type | Individual
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Provider Name | JUSTIN T LAI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 15455 MEMORIAL DR # 400 EDGE DENTAL
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City | HOUSTON
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State | TX
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Zip | 77079-4135
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Country | US
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Telephone | 281-940-8940
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Fax |
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Provider Business Mailing Address
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Address Line | 15455 MEMORIAL DR # 400 EDGE DENTAL
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City | HOUSTON
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State | TX
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Zip | 77079-4135
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Country | US
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Telephone | 281-940-8940
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 29013
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License Number State | TX
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