Provider Demographics
NPI:1780781385
Name:LAM, TRUNG QUOC (DDS)
Entity type:Individual
Prefix:
First Name:TRUNG
Middle Name:QUOC
Last Name:LAM
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 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:STE #200
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-498-7733
Mailing Address - Fax:301-470-2211
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:STE #200
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-498-7733
Practice Address - Fax:301-470-2211
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist