Provider Demographics
NPI:1508922782
Name:LAM, WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:WALTER
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 1:723 S GARFIELD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4426
Mailing Address - Country:US
Mailing Address - Phone:626-289-1020
Mailing Address - Fax:
Practice Address - Street 1:723 S GARFIELD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4426
Practice Address - Country:US
Practice Address - Phone:626-289-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist