Provider Demographics
NPI:1831413350
Name:LAM DENTAL CORP
Entity type:Organization
Organization Name:LAM DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-458-2516
Mailing Address - Street 1:10165 FOOTHILL BLVD
Mailing Address - Street 2:SUITE # 4, 5
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0340
Mailing Address - Country:US
Mailing Address - Phone:818-458-2516
Mailing Address - Fax:
Practice Address - Street 1:10165 FOOTHILL BLVD
Practice Address - Street 2:SUITE # 4, 5
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0340
Practice Address - Country:US
Practice Address - Phone:818-458-2516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty