Individual provider Active NPI

Jenna Y Lau, DDS

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1235470519
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D011262 Issued in AZ
Practice address
635 E Baseline Rd
Phoenix, AZ 85042-6583
Phone
(602) 243-7277
NPI assigned
Mar 11, 2013
Last updated
Jun 29, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D011262 AZ Primary
General Practice Dentistry 1223G0001X 63747 CA

Addresses

Primary practice location

635 E Baseline Rd
Phoenix, AZ 85042-6583

Mailing address

635 E Baseline Rd
Phoenix, AZ 85042-6583
Phone (602) 243-7277

Other practice location 1

5850 E Still Cir
Mesa, AZ 85206-3618
Phone (480) 248-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160503001149 CA Order and Referring Only - DentistPractitioner - Dentist 2163721721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63747CAMDSchool Psychologist
D011262AZMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1235470519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 E BASELINE RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850426583",
            "telephone_number": "602-243-7277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 E BASELINE RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850426583",
            "telephone_number": "602-243-7277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5850 E Still Cir",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852063618",
            "country_code": "US",
            "telephone_number": "480-248-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAU",
        "first_name": "JENNA",
        "middle_name": "Y",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-11",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011262",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63747",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.