Provider Demographics
NPI:1245365550
Name:HOANG, LAM (DDS)
Entity type:Individual
Prefix:
First Name:LAM
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 BROWN TRL
Mailing Address - Street 2:#C
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6497
Mailing Address - Country:US
Mailing Address - Phone:817-510-2960
Mailing Address - Fax:817-510-2967
Practice Address - Street 1:1404 BROWN TRL
Practice Address - Street 2:#C
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6497
Practice Address - Country:US
Practice Address - Phone:817-510-2960
Practice Address - Fax:817-510-2967
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7067122300000X
CA42326122300000X
TX23212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist