Provider Demographics
NPI:1134274160
Name:LAMUS, MYRIAM P (DENTIST GP)
Entity type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:P
Last Name:LAMUS
Suffix:
Gender:F
Credentials:DENTIST GP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 81ST ST
Mailing Address - Street 2:SUIT 1I
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6970
Mailing Address - Country:US
Mailing Address - Phone:718-898-7003
Mailing Address - Fax:718-898-7549
Practice Address - Street 1:3725 81ST ST
Practice Address - Street 2:SUIT 1I
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6970
Practice Address - Country:US
Practice Address - Phone:718-898-7003
Practice Address - Fax:718-898-7549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist