Provider Demographics
NPI:1326411315
Name:LAM, JIM DATCHIEU (DDS)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:DATCHIEU
Last Name:LAM
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 1:10250 COTTONWOOD PARK NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-7018
Mailing Address - Country:US
Mailing Address - Phone:505-890-0858
Mailing Address - Fax:505-890-1402
Practice Address - Street 1:10250 COTTONWOOD PARK NW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-7018
Practice Address - Country:US
Practice Address - Phone:505-890-0858
Practice Address - Fax:505-890-1402
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice