Provider Demographics
NPI:1447371968
Name:LAW, LAN (DDS)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 CINCINNATI DAYTON RD STE Y
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6630
Mailing Address - Country:US
Mailing Address - Phone:513-777-4111
Mailing Address - Fax:
Practice Address - Street 1:7908 CINCINNATI DAYTON RD STE Y
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6630
Practice Address - Country:US
Practice Address - Phone:513-777-4111
Practice Address - Fax:513-777-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-88571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0804811Medicaid
OH31-1310884OtherTIN