Provider Demographics
NPI:1851389944
Name:LAM, KELLY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:B
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 HAMNER AVE
Mailing Address - Street 2:100
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1920
Mailing Address - Country:US
Mailing Address - Phone:951-520-8725
Mailing Address - Fax:951-520-8796
Practice Address - Street 1:2488 HAMNER AVE
Practice Address - Street 2:100
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1920
Practice Address - Country:US
Practice Address - Phone:951-520-8725
Practice Address - Fax:951-520-8796
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA514861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice