Provider Demographics
NPI:1538371950
Name:ROSS CARLTON LAI DDS DENTAL GROUP
Entity type:Organization
Organization Name:ROSS CARLTON LAI DDS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-391-9000
Mailing Address - Street 1:456 MONTGOMERY ST
Mailing Address - Street 2:SUITE # GC-3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1233
Mailing Address - Country:US
Mailing Address - Phone:415-391-9000
Mailing Address - Fax:415-391-9019
Practice Address - Street 1:456 MONTGOMERY ST
Practice Address - Street 2:SUITE # GC-3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1233
Practice Address - Country:US
Practice Address - Phone:415-391-9000
Practice Address - Fax:415-391-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty