Provider Demographics
NPI:1447383286
Name:LAM, DIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIN
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INDIAN TRAIL RD S
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9101
Mailing Address - Country:US
Mailing Address - Phone:704-839-0535
Mailing Address - Fax:704-839-0549
Practice Address - Street 1:301 INDIAN TRAIL RD S
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9101
Practice Address - Country:US
Practice Address - Phone:704-839-0535
Practice Address - Fax:704-839-0549
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-012141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164979589Medicaid