Healthcare Provider Details

I. General information

NPI: 1477700250
Provider Name (Legal Business Name): DOMINIC CHENG-WEI TAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W COMBS RD STE 102
QUEEN CREEK AZ
85140-9102
US

IV. Provider business mailing address

857 E LIBRA PL
CHANDLER AZ
85249-3642
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8580
  • Fax:
Mailing address:
  • Phone: 510-432-5491
  • Fax: 480-831-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number008315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: