Provider Demographics
NPI:1033378773
Name:TAM, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 GENERAL BOOTH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4092
Mailing Address - Country:US
Mailing Address - Phone:757-427-9300
Mailing Address - Fax:757-427-0685
Practice Address - Street 1:2236 GENERAL BOOTH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4092
Practice Address - Country:US
Practice Address - Phone:757-427-9300
Practice Address - Fax:757-427-0685
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP585871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice