Provider Demographics
NPI:1275068249
Name:LAM, CARMEN (DDS)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:LAM
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 1:120 CENTRAL PARK S STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1508
Mailing Address - Country:US
Mailing Address - Phone:347-325-2665
Mailing Address - Fax:
Practice Address - Street 1:120 CENTRAL PARK S STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1508
Practice Address - Country:US
Practice Address - Phone:347-325-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist