Provider Demographics
NPI:1407159395
Name:LAM, JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:5435 N GARLAND AVE
Mailing Address - Street 2:STE. 125
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2785
Mailing Address - Country:US
Mailing Address - Phone:972-530-7374
Mailing Address - Fax:972-499-7740
Practice Address - Street 1:5435 N GARLAND AVE
Practice Address - Street 2:STE. 125
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2785
Practice Address - Country:US
Practice Address - Phone:972-530-7374
Practice Address - Fax:972-499-7740
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60031122300000X
TX27537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist