Provider Demographics
NPI:1891927695
Name:LAM, LORETTA (DDS)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:LAM
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 1:208 W. CERMAK RD
Mailing Address - Street 2:SUITE 822
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-339-5102
Mailing Address - Fax:312-263-0906
Practice Address - Street 1:208 W. CERMAK RD
Practice Address - Street 2:SUITE 822
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-339-5102
Practice Address - Fax:312-263-0906
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0248291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice