Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2013016299 | MO |
N | 122300000X | Dentist | D13459 | MN |
NPI | 1003256876 |
---|---|
Provider Name | Eva Lau |
First Address | Minnetonka, MN 55343-8912 |
Second Address | Minnetonka, MN 55343-8912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 20/08/2014 |