Provider Demographics
NPI:1124670252
Name:LAM DENTISTRY
Entity type:Organization
Organization Name:LAM DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-230-8090
Mailing Address - Street 1:13317 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6816
Mailing Address - Country:US
Mailing Address - Phone:225-644-4000
Mailing Address - Fax:225-644-4040
Practice Address - Street 1:37341 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-644-4000
Practice Address - Fax:225-644-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental