Provider Demographics
NPI:1881807709
Name:LAM, EDDIE H (DMD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:H
Last Name:LAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-869-9597
Mailing Address - Fax:301-869-8170
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-869-9597
Practice Address - Fax:301-869-8170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice