Provider Demographics
NPI:1073532594
Name:LAM, CAROL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:H
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:626 WILSHIRE BLVD
Mailing Address - Street 2:STE. 920
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3209
Mailing Address - Country:US
Mailing Address - Phone:213-622-9159
Mailing Address - Fax:213-622-1502
Practice Address - Street 1:626 WILSHIRE BLVD
Practice Address - Street 2:STE. 920
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3209
Practice Address - Country:US
Practice Address - Phone:213-622-9159
Practice Address - Fax:213-622-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice