Provider Demographics
NPI:1467505255
Name:LAM, MAUREEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13347 SANFORD AVE STE C1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5816
Mailing Address - Country:US
Mailing Address - Phone:718-888-8828
Mailing Address - Fax:718-888-8827
Practice Address - Street 1:13347 SANFORD AVE STE C1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5816
Practice Address - Country:US
Practice Address - Phone:718-888-8828
Practice Address - Fax:718-888-8827
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY393251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02337635Medicaid