Healthcare Provider Details

I. General information

NPI: 1679509210
Provider Name (Legal Business Name): NATALIE LAM D.M.D., M.M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 LA SENDITA SUITE B1
RANCHO SANTA FE CA
92067
US

IV. Provider business mailing address

PO BOX 305
RANCHO SANTA FE CA
92067-0305
US

V. Phone/Fax

Practice location:
  • Phone: 858-756-5900
  • Fax: 858-381-5220
Mailing address:
  • Phone: 858-756-5900
  • Fax: 858-381-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401411149
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number59300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: