Provider Demographics
NPI:1386003440
Name:LAM, JEFFREY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11588 LAWTON CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3326
Mailing Address - Country:US
Mailing Address - Phone:909-633-7298
Mailing Address - Fax:
Practice Address - Street 1:10 SINARAN DRIVE #11-04
Practice Address - Street 2:
Practice Address - City:SINGAPORE
Practice Address - State:SINGAPORE
Practice Address - Zip Code:307506
Practice Address - Country:SG
Practice Address - Phone:656-250-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605865861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics