Provider Demographics
NPI:1982038105
Name:LAM, MARIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 58TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2025
Mailing Address - Country:US
Mailing Address - Phone:201-281-2687
Mailing Address - Fax:
Practice Address - Street 1:3237 58TH ST
Practice Address - Street 2:APT 1
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2025
Practice Address - Country:US
Practice Address - Phone:201-281-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0569031223G0001X
NJ22DI025180001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice