Provider Demographics
NPI:1073641577
Name:THAM, SERENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:THAM
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 1:1050 140TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2972
Mailing Address - Country:US
Mailing Address - Phone:425-373-3000
Mailing Address - Fax:
Practice Address - Street 1:1050 140TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2972
Practice Address - Country:US
Practice Address - Phone:425-373-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521201223G0001X
WA612372981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice