Provider Demographics
NPI:1275012684
Name:KATHY LAM DDS, LLC
Entity Type:Organization
Organization Name:KATHY LAM DDS, LLC
Other - Org Name:DEKALB FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-653-7720
Mailing Address - Street 1:210 CHAPIN WAY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5010
Mailing Address - Country:US
Mailing Address - Phone:630-346-0563
Mailing Address - Fax:
Practice Address - Street 1:311 S NAPERVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5473
Practice Address - Country:US
Practice Address - Phone:630-653-7720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026695261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental