Provider Demographics
NPI:1386897940
Name:LAU, KELCEY (DDS)
Entity type:Individual
Prefix:
First Name:KELCEY
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31333 TEMECULA PKWY
Mailing Address - Street 2:STE. 110
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6831
Mailing Address - Country:US
Mailing Address - Phone:951-308-2183
Mailing Address - Fax:951-308-2158
Practice Address - Street 1:31333 TEMECULA PKWY
Practice Address - Street 2:STE. 110
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6831
Practice Address - Country:US
Practice Address - Phone:951-308-2183
Practice Address - Fax:951-308-2158
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice