Provider Demographics
NPI:1477700250
Name:TAM, DOMINIC CHENG-WEI (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:CHENG-WEI
Last Name:TAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 E LIBRA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3642
Mailing Address - Country:US
Mailing Address - Phone:510-432-5491
Mailing Address - Fax:480-831-6054
Practice Address - Street 1:2905 W WARNER RD
Practice Address - Street 2:SUITE 15
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-831-8100
Practice Address - Fax:480-831-6054
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412072122300000X
AZ008315122300000X
PADS038580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist