Provider Demographics
NPI:1043613268
Name:NAM, ALBERT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:NAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11206 SW 93RD COURT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-5252
Mailing Address - Country:US
Mailing Address - Phone:352-390-2219
Mailing Address - Fax:
Practice Address - Street 1:11206 SW 93RD COURT RD STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5252
Practice Address - Country:US
Practice Address - Phone:352-390-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11299122300000X, 1223G0001X
FL276391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11299OtherCT DPH