Provider Demographics
NPI:1174724850
Name:LAI, JIMMY (DMD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121G REVERE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2983
Mailing Address - Country:US
Mailing Address - Phone:780-828-3182
Mailing Address - Fax:
Practice Address - Street 1:572 PLEASANT ST
Practice Address - Street 2:1F
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3550
Practice Address - Country:US
Practice Address - Phone:781-397-8876
Practice Address - Fax:781-324-7166
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist