Provider Demographics
NPI:1326693037
Name:LAM, JESSICA TAK-WAI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TAK-WAI
Last Name:LAM
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 1:3338 THE CRESCENT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V6H1T8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1718 S 288TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-2981
Practice Address - Country:US
Practice Address - Phone:253-839-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609616871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty