Provider Demographics
NPI:1619245214
Name:DICK M HOM DDS & PRITCHARD Y LAM DDS PARTNERSHIP
Entity Type:Organization
Organization Name:DICK M HOM DDS & PRITCHARD Y LAM DDS PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-676-1440
Mailing Address - Street 1:1925 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2525
Mailing Address - Country:US
Mailing Address - Phone:925-676-1440
Mailing Address - Fax:925-676-0313
Practice Address - Street 1:1925 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2525
Practice Address - Country:US
Practice Address - Phone:925-676-1440
Practice Address - Fax:925-676-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2832901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT92233Medicare UPIN
CAT08910Medicare UPIN