Healthcare Provider Details

I. General information

NPI: 1639371800
Provider Name (Legal Business Name): EUGENE KEITH LAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-0999
US

IV. Provider business mailing address

4247 LOCUST ST APT 623
PHILADELPHIA PA
19104-5252
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5732
  • Fax:
Mailing address:
  • Phone: 215-243-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901019594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: