Provider Demographics
NPI:1013200187
Name:LAM, COLLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 S CONGRESS AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4723
Mailing Address - Country:US
Mailing Address - Phone:561-965-6003
Mailing Address - Fax:561-965-8447
Practice Address - Street 1:5057 S CONGRESS AVE STE 401
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4723
Practice Address - Country:US
Practice Address - Phone:561-965-6003
Practice Address - Fax:561-965-8447
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10833OtherDELTA DENTAL, BLUE CROSS