MEDICARE: DR. JOSEPH S LAU D.D.S.

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	9946	GA

General Provider Information

NPI Number	:	1760509509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S LAU D.D.S.

Provider Business Mailing Address
First Line	:	3020 MERCER UNIVERSITY DR STE 200
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4145
Country	:	US
Telephone Number	:	770-817-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MERCER UNIVERSITY DR
Second Line	:	SUITE#200
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4145
Country	:	US
Telephone Number	:	770-817-9400
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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