Provider Demographics
NPI:1861601346
Name:LAU, MAN-CHEUNG (DDS MS)
Entity type:Individual
Prefix:DR
First Name:MAN-CHEUNG
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4875
Mailing Address - Country:US
Mailing Address - Phone:419-504-1133
Mailing Address - Fax:419-504-1030
Practice Address - Street 1:236 W PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4875
Practice Address - Country:US
Practice Address - Phone:419-504-1133
Practice Address - Fax:419-504-1030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0211911223G0001X
OH30-211911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253387Medicaid