Provider Demographics
NPI:1679689772
Name:LUM, ROBERT MARK (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:LUM
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 1:39572 STEVENSON PLACE
Mailing Address - Street 2:SUIT 223
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539
Mailing Address - Country:US
Mailing Address - Phone:510-792-3286
Mailing Address - Fax:510-792-3298
Practice Address - Street 1:39572 STEVENSON PLACE
Practice Address - Street 2:SUIT 223
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539
Practice Address - Country:US
Practice Address - Phone:510-792-3286
Practice Address - Fax:510-792-3298
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist