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General NPI Number Information
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NPI Number | 1083386114
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Entity Type | Organization
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Legal Business Name | JIM LAM DDS PLLC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 6821 DONIPHAN DR
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City | CANUTILLO
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State | TX
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Zip | 79835-5402
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Country | US
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Telephone | 915-877-4949
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Fax | 915-877-4242
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Provider Business Mailing Address
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Address Line | 6821 DONIPHAN DR
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City | CANUTILLO
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State | TX
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Zip | 79835-5402
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Country | US
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Telephone | 915-877-4949
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Fax | 915-877-4242
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JIM LAM
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Credential | DDS
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Telephone | 626-235-6572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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