MEDICARE: DR. EN LIENG LAI 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	DN13549	FL

General Provider Information

NPI Number	:	1275751190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EN LIENG LAI DMD

Provider Business Mailing Address
First Line	:	6605 W BOYNTON BEACH BLVD
Second Line	:	FOUNTAINS OF BOYNTON DENTAL CTR
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3526
Country	:	US
Telephone Number	:	561-364-8088
Fax Number	:	561-742-2808

Provider Business Practice Location Address
First Line	:	6605 W BOYNTON BEACH BLVD
Second Line	:	FOUNTAINS OF BOYNTON DENTAL CTR
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3526
Country	:	US
Telephone Number	:	561-364-8088
Fax Number	:	561-742-2808

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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