Provider Demographics
NPI:1831313311
Name:NAM, ELLEN MEEYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MEEYOUNG
Last Name:NAM
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 1:3705 LAKEVIEW PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4177
Mailing Address - Country:US
Mailing Address - Phone:972-475-2321
Mailing Address - Fax:
Practice Address - Street 1:3705 LAKEVIEW PKWY
Practice Address - Street 2:STE 101
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4177
Practice Address - Country:US
Practice Address - Phone:972-475-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice